高剂量脂质体两性霉素B继以口服氟康唑成功治疗骨关节炎隐球菌病
Osteoarticular Cryptococcosis Successfully Treated with High-Dose Liposomal Amphotericin B Followed by Oral Fluconazole.
作者信息
Deus Guillem, Gómez-Zorrilla Silvia, Echeverria-Esnal Daniel, Siverio Ana, Güerri-Fernandez Robert, Ares Jesús, Campillo Nuria, Letang Emili, Knobel Hernando, Grau Santiago, Horcajada Juan Pablo
机构信息
Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, Barcelona, Spain.
Pharmacy Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
出版信息
Infect Drug Resist. 2021 Feb 24;14:719-722. doi: 10.2147/IDR.S294299. eCollection 2021.
BACKGROUND
Skeletal involvement of is infrequent and usually associated with disseminated cryptococcosis or underlying predisposing conditions. We present an atypical case of osteoarticular cryptococcosis in an immunocompetent patient.
CASE PRESENTATION
We herein report a case of bone and soft tissue cryptococcal infection in a 42-year-old male from Pakistan with well-controlled diabetes without other associated immunodeficiencies treated with antifungal therapy without surgical debridement. Furthermore, the patient developed toxidermia due to fluconazole use, so a fluconazole desensitization was performed. Therapeutic management also included the performance of therapeutic drug monitoring of fluconazole plasma concentrations.
CONCLUSION
To our knowledge, this is the first case of osteoarticular cryptococcosis treated with this treatment regimen. This strategy may be of interest to try to reduce hospital stay and associated complications.
背景
隐球菌病累及骨骼的情况并不常见，通常与播散性隐球菌病或潜在的易感因素有关。我们报告了一例免疫功能正常患者的非典型骨关节炎性隐球菌病病例。
病例介绍
我们在此报告一例来自巴基斯坦的42岁男性患者，患有骨与软组织隐球菌感染，其糖尿病病情控制良好，无其他相关免疫缺陷，接受了抗真菌治疗，未进行手术清创。此外，该患者因使用氟康唑出现了中毒性表皮坏死松解症，因此进行了氟康唑脱敏治疗。治疗管理还包括对氟康唑血浆浓度进行治疗药物监测。
结论
据我们所知，这是首例采用该治疗方案治疗的骨关节炎性隐球菌病病例。这种策略可能有助于减少住院时间及相关并发症，值得一试。
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