Miliary coccidioidomycosis is a severe manifestation of diseases caused by Coccidioides immitis and Coccidioides posadasii that is endemic to the southwestern United States as well as Central and South America. While most cases of coccidioidomycosis present with pulmonary disease, certain risk factors increase the risk for disseminated disease. We present a case of miliary coccidioidomycosis in a 46-year-old patient with uncontrolled diabetes. Additionally, we review the features of thirty-seven cases of patients with miliary coccidioidomycosis.
Here, we present the case of an otherwise healthy patient, without risk factors, who developed a refractory case of onychomycosis caused by Kloeckera apiculata, an uncommon human pathogen. The diagnosis was ultimately confirmed by fungal nail plate culture, histopathology, and PCR. Whereas prior treatments with topical 5 % tavaborole solution, oral terbinafine, and oral fluconazole were ineffective, complete clinical and mycological cure was achieved with a 3-month course of oral itraconazole.
We report a case of sporotrichosis in an elderly male farmer at the site of a cat scratch scar.
An 84-year-old Japanese farmer was scratched by his cat two months before his visit to our hospital.
A skin biopsy was performed. Tissue culture revealed the presence of Sporothrix globosa.
The patient was treated with oral itraconazole 200 mg/day for 13 months due to a slow healing ulceration, and the symptoms resolved. (71 words).
A 78-year-old woman presented to hospital with altered mental status. Hyponatremia was diagnosed and treated. She maintained mental confusion despite normal sodium. No headache, fever or focal signs were present. CSF analysis showed chronic meningitis; MRI demonstrated basilar enhancement. She was empirically treated for tuberculosis, with no improvement. PCR for Sporothrix in the CSF was positive. After treatment with Amphotericin followed by oral itraconazole, she completely recovered her cognitive abilities. Follow-up CSF was normal. This report illustrates the need to consider sporotrichosis in the differential diagnosis of chronic meningitis in immunocompetent, and the importance of PCR as a diagnostic tool.
Chronic pulmonary aspergillosis (CPA) treatment in Africa remains unexplored. We present a 23-year-old Ugandan male, previously treated thrice for pulmonary tuberculosis, developing CPA. Imaging showed lung fibrosis, bronchiectasis, and a fungal ball. He received weekly 600mg (10mg/kg) of liposomal amphotericin B for six weeks, leading to marked clinical improvement. Weekly liposomal amphotericin B may be a viable treatment option for CPA in resource-limited settings.
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