Dermatophytes usually do not invade beyond the epidermis. However mechanical breakage of the skin resulting from scratching or trauma and immunocompromised state, such as diabetes mellitus, lymphoma, and long-term steroid use may allow penetration of the fungi into reticular dermis. Cutaneous granulomas produced by infection with superficial fungi are infrequently recognized. We report four cases of dermatophytic granuloma on the lower extremities. Histopathologic examinations of the skin lesions of four patients showed chronic granulomatous inflammation with fungal elements. Cultures of Sabouraud's media with excised tissue revealed Trichophyton(T.) rubrum in two patients and T. mentagrophytes in one patient. The patients were treated with oral administration of terbinafine or itraconazole for 2-4 weeks.
Administration, Oral ; Arthrodermataceae ; Dermis ; Diabetes Mellitus ; Epidermis ; Fungi ; Granuloma* ; Humans ; Inflammation ; Itraconazole ; Lower Extremity ; Lymphoma ; Skin

Drug eruptions are common, occurring in 2% to 3% of hospitalized patients. The majority of reactions are mild, accompanied by pruritus, resolving promptly after the offending drug is discontinued. An eruption caused by itraconazole is very rare and there have been no previous reports in Korea. A 60-year-old man was seen with multiple erythematous papules and patches that appeared after oral administration of itraconazole and gradually the skin lesions changed to purpura. Given the widespread use of itraconazole for onychomycosis, a purpuric drug eruption should be considered a rare complication of therapy.
Administration, Oral ; Drug Eruptions* ; Humans ; Itraconazole* ; Korea ; Middle Aged ; Onychomycosis ; Pruritus ; Purpura ; Skin

We report a case of Majocchi's granuloma in a 71-year-old immunocompetent male patient, who presented with a 6-month history of mass with multiple erythematous nodules and indurated plaques with scale on the left cheek. Even though the lesion strongly suggested cutaneous tumor, the histopathologic findings were consistent with the Majocchi's granuloma, showing numerous hyphae, perifolliculitis and granulomatous inflammation with central abscess formation in the dermis. Trichophyton rubrum was isolated from the biopsy specimen fungus culture. The cutaneous lesion was treated with oral administration of itraconazole (200 mg/day) and topical lanoconazole cream for 4 weeks, and successfully treated.
Abscess ; Administration, Oral ; Aged ; Biopsy ; Cheek ; Dermis ; Fungi ; Granuloma* ; Humans ; Hyphae ; Inflammation ; Itraconazole ; Male ; Trichophyton

PURPOSE: To investigate the clinical efficacy of intracameral amphotericin injection and to evaluate risk factors affecting primary treatment success in fungal infection invading the anterior segment of the eye. METHODS: Twenty-six eyes of 26 patients diagnosed with fungal infection in the anterior segment were studied. The initial treatment regimen was a topical 0.15% amphotericin application and itraconazole oral administration after culture. Amphotericin (5 ug/0.1 ml, 0.1 cc) was repeatedly injected intracamerally when the infection intensified. Penetrating keratoplasty was conducted for eyes unresponsive to intracameral amphotericin injection. The relative risk ratios of ulcer size, infiltration depth, culture positivity, and hypopyon were compared in each treatment group to evaluate the treatment response. RESULTS: Of patients with fungal infection, 30.7% were cured with intracameral amphotericin injection, while 30.7% needed penetrating keratoplasty. Intracameral amphotericin injection was needed in the presence of large corneal ulcers (>14 mm2), hypopyon, positive fungal culture, use of steroid eye drops, and deep infiltration at initial examination. Large ulcer size (>14 mm2) was the main risk factor for needing penetrating keratoplasty. Of the eyes Candida infection, 66.5% needed evisceration. CONCLUSIONS: Large ulcer size and the isolation of Candida were poor prognostic factors related to the efficacy of intracameral amphotericin injection.
Administration, Oral ; Amphotericin B* ; Candida ; Humans ; Itraconazole ; Keratoplasty, Penetrating ; Odds Ratio ; Ophthalmic Solutions ; Risk Factors* ; Ulcer

Human ; Male ; Adolescent ; Antifungal Agents ; Double-blind Method ; Drug Administration Schedule ; Itraconazole ; Tinea Versicolor

OBJECTIVEChronic pulmonary aspergillosis is different from acute pulmonary aspergillosis in clinical picture, radiogram, diagnostic procedures and prognosis. Four patients with chronic pulmonary aspergillosis had been misdiagnosed as having pneumonia or pulmonary tuberculosis for a long time before admission to the hospital. The purpose of this report was to summarize the clinical manifestations and laboratory findings for correct diagnosis of chronic pulmonary aspergillosis.

METHODSFour patients with chronic pulmonary aspergillosis seen between October 2002 and October 2004 were retrospectively studied. Their clinical manifestations, chest radiographic feature, immune status, diagnostic procedure, therapy and prognosis were reviewed.

RESULTSThe chief complaints of these patients were chronic cough and fever for 3 to 12 months. Chest wall abscess developed in the late course in case 1 and 4. Fine moist rales were heard and hepatosplenomegaly was found in case 1 and 2. No abnormal sign was found in case 3 and 4. Chest radiographic feature: lobar consolidation with adjacent pleural thickening was present in all cases. In early phase, solitary or multiple small nodules were found in 2 cases. Case 1-3 had normal IgG, IgM, IgA, IgE, T Cell subsets and NBT test. Case 4 had chronic granulomatous disease. Etiologic evidences: culture was positive for Aspergillus (A.) fulmigatus in sputum and in chest wall abscess in case 1 and 4; for A. niger in sputum and spore existing in lung tissue in case 2; for A. fulmigatus in sputum and hypha existing in lung tissue in case 3. All patients were treated with combination of amphotericin B and itraconazole. Their symptoms were controlled 10-30 d after treatment. In case 1 the disease relapsed 6 months later and the patient died at last due to giving up treatment by his parents. Case 2 was free of symptom for 12 months and his chest radiographic lesion disappeared completely 6 months later. Treatment of case 4 was given up. Case 3 continued to receive treatment and observation.

CONCLUSIONChronic pulmonary aspergillosis should be considered in children with long period fever and cough and lobar consolidation associated with adjacent pleural thickening or with nodular infiltration. The diagnosis of chronic pulmonary aspergillosis depended on identification of aspergillus from sputum or lung tissue. Combined amphotericin B and itraconazole might control the disease.

Amphotericin B ; administration & dosage ; Child ; Child, Preschool ; Chronic Disease ; Drug Therapy, Combination ; Female ; Humans ; Infant ; Itraconazole ; administration & dosage ; Male ; Pulmonary Aspergillosis ; diagnosis ; drug therapy

OBJECTIVETo explore the rate of compliance, influencing factors and the safety of patients with onychomycosis under treatment of oral antifungal agents.

METHODSAccording to the scoring clinical index of onychomycosis (SCIO), 330 patients with onychomycosis, their target nail's integral of the SCIO were calculated and randomly divided into three groups under the baseline of the SCIO integral range. Patients were treated with intermittent pulse itraconazole (A group), continuous terbinafine (B group) and intermittent terbinafine (C group) respectively. Self-administered questionnaire was applied in the survey on every onychomycosis patient.

RESULTSThe average rate of compliance was 55.15%. The cure rate for those compliance with doctors' order was 89.01%, while it was only 30.41% for those noncompliant patients The overall non-compliant rate was 44.85%. Among the noncompliant ones, 29.73% were worried about the side effects of medicine, 22.30% thought that they had already been cured, 15.54% was due to economic reasons and 12.16% could not bear the side effects of medicine. It was found that the compliant rates were significantly correlated to ageing, position of the target nails, the integral of the SCIO and the therapy scheme (P < 0.05), while no significant correlations were seen between male and female, culture degree and course (P > 0.1). The frequency of adverse incident of A, B, C groups were 22.73%, 21.43%, 23.15% respectively, but without statistical significance (P > 0.1). Majority of the adverse incidents happened during the first month of therapy but were mild and reversible.

CONCLUSIONOur results showed that the overall compliance was low which exerted a significant influence on the curative effect of onychomycosis patients. Factors as ageing, position of the target nail, integral of the SCIO and the therapy scheme had an influence on the compliant rate. When treating onychomycosis with oral itraconazole, the results seemed to be just as safe as when using terbinafine.

Administration, Oral ; Age Factors ; Antifungal Agents ; administration & dosage ; adverse effects ; economics ; Dose-Response Relationship, Drug ; Female ; Humans ; Itraconazole ; administration & dosage ; adverse effects ; economics ; Male ; Naphthalenes ; administration & dosage ; adverse effects ; economics ; Onychomycosis ; drug therapy ; Patient Compliance ; statistics & numerical data ; Surveys and Questionnaires

Sporotrichosis is a chronic infectious disease caused by Sporothrix(S.) schenckii. Regional lymphatic sporotrichosis is common type, accounting for 75% of the cases. But fixed cutaneous sporotrichosis is seen in 20% of cases. We report two cases of fixed cutaneous sporotrichosis in a 48-year-old man and 8-year-old boy. The lesions were manifested by erythematous plaques on right arm and left cheek, respectively. The fungal culture from biopsy specimen on Sabouraud's dextrose agar showed dark brown to black, moist and wrinkled colonies of S. schenckii. Histopathologically, pseudoepitheliomatous hyperplasia and chronic granulomatous inflammation were observed on H & E stain. The patients were treated with surgical excision of lesion & oral administration of 30 drops of saturated solution of potassium iodide three times a day and 100 mg of itraconazole daily for 3 months, respectively. Skin lesions were completely cured and recurrence is not observed to date.
Administration, Oral ; Agar ; Arm ; Biopsy ; Cheek ; Child ; Communicable Diseases ; Glucose ; Humans ; Hyperplasia ; Inflammation ; Itraconazole ; Male ; Middle Aged ; Potassium Iodide ; Recurrence ; Skin ; Sporotrichosis*

Chromoblastomycosis is a chronic fungal infection of the skin and subcutaneous tissues caused by pigmented or dematiaceous fungi that are implanted into the dermis from the external environment. The vast majority of infections are caused by Fonsecaea pedrosoi and Cladosporium carrionii. Several drugs, such as itraconazole, amphotericin B, terbinafine, have been tried with variable success and various therapeutic techniques, including radiotherapy, cryosurgery, electrodesiccation and surgical excision, can be applied as a further treatment. So far, there are five cases filed as chromoblastomycosis in Korea. Four of them are reported from the southern part of the Korea. Intralesional injection or occlusive dressing of Amphotericin B, and oral administration of intraconazole have been used for the treatment in reported cases. Now, we report firstly a case of chromoblastomycosis treated with terbinafine. A 54-year-old Korean teacher had 10 x 5.5 cm sized dark purple colored plaque with crusts 4 years earlier as a linear plaque after an injury by the thorns of wooden chair. A skin biopsy revealed pseudoepitheliomatous hyperplasia and dermal infiltration of mixed inflammatory cells and Touton type multinucleated giant cells with numerous sclerotic cells. Several clusters of sclerotic bodies were observed also within the giant cells. On the fungus culture, the colony showed slowly growing dark-brown colored heaped appearance in 4 weeks. Isolated fungus was identified as Fonsecaea pedrosoi. Because of partial response to 10 months' itraconazole treatment, the treatment regimen was changed to terbinafine 500 mg/d with marked improvement after 4 months.
Administration, Oral ; Amphotericin B ; Biopsy ; Chromoblastomycosis* ; Cladosporium ; Cryosurgery ; Dermis ; Fungi ; Giant Cells ; Humans ; Hyperplasia ; Injections, Intralesional ; Itraconazole ; Korea ; Middle Aged ; Occlusive Dressings ; Radiotherapy ; Skin ; Subcutaneous Tissue

BACKGROUND: Invasive aspergillosis is an important cause of morbidity and mortality in neutropenic patients after chemotherapy in hematologic malignancies. HEPA filtration was known as an effective preventive measure for invasive aspergillosis, but the role of chemoprophylaxis has not been established yet. Itraconazole has been considered to be an effective antifungal agent for invasive aspergillosis. We evaluated the effect of itraconazole chemoprophylaxis in the prevention of invasive aspergillosis for neutropenic patients after chemotherapy in hematologic malignancies, who were treated in general ward without HEPA filtration. METHODS: A total of 89 patients with hematologic malignancies were enrolled in the two groups between January, 1995 and December, 1997 at Samsung medical center. Itraconazole, 200 mg po twice daily, was given to the patients as their neutrophil count decreased below 1,000/microliter following chemotherapy, and continued until it recovered over 1,000/microliter. Incidence of invasive aspergillosis was prospectively compared between the itraconazole prophylaxis group and the control group. RESULTS: Itraconazole prophyaxis was done in 34 patients on a total 59 episodes of severe neutropenia (absolute neutrophil count <500/microliter) after chemotherapy. Two out of 34 patients were histologically diagnosed as invasive aspergillosis. Control group included 55 patients with 103 episodes of severe neutropenia. Five out of 55 patients were diagnosed as invasive aspergillosis. No statistically significant differences were observed between two groups, because 2 of 59 (3.4%) and 5 of 103 (4.9%) were found to have invasive aspergillosis proven histologically (P=1.00). CONCLUSION: Itraconazole chemoprophylaxis for invasive aspergillosis was not effective, and the prognosis was closely related to the recovery of neutrophils. But we cannot exclude thepossibility that the drug has been failed in achieving effective plasma concentration by oral administration, as reported in several studies. Randomized prospective study, including measurement of plasma drug concentration, is warranted to evaluate the efficacy of itraconazole for the prevention of invasive aspergillosis.
Administration, Oral ; Aspergillosis* ; Chemoprevention ; Drug Therapy ; Filtration ; Hematologic Neoplasms ; Humans ; Incidence ; Itraconazole* ; Mortality ; Neutropenia ; Neutrophils ; Patients' Rooms ; Plasma ; Prognosis ; Prospective Studies