Noguchi Hiromitsu, Matsumoto Tadahiko, Kimura Utako, Hiruma Masataro, Kano Rui, Yaguchi Takashi, Kubo Masahide, Kashiwada-Nakamura Kayo, Fukushima Satoshi
Noguchi Dermatology Clinic, Kumamoto, Japan.
Ochanomizu Institute for Medical Mycology and Allergology, Tokyo, Japan.
J Dermatol. 2022 May;49(5):564-571. doi: 10.1111/1346-8138.16312. Epub 2022 Feb 25.
We encountered two cases of phaeohyphomycosis caused by Exophiala jeanselmei and E. oligosperma that were treated with fosravuconazole and terbinafine, respectively. Our cases were successfully treated with empiric therapy before the pathogen's species or antifungal sensitivity had been determined. We summarized 32 cases of cutaneous and subcutaneous phaeohyphomycosis caused by Exophiala species in Japan. The patients received antifungals, including itraconazole, terbinafine, voriconazole, and fosravuconazole, and the treatment success rates of these monotherapies were 77% (17/22), 67% (8/12), 100% (5/5), and 50% (1/2), respectively. Although the broad-spectrum azole antifungal itraconazole is the first choice for treatment, terbinafine at 125 mg/day might exert the same efficacy. Fosravuconazole is a novel broad-spectrum azole and a moderate inhibitor of Cyp3A4 that causes fewer drug interactions than itraconazole and voriconazole, indicating a promising drug for this disease.
我们遇到了两例分别由甄氏外瓶霉和少孢外瓶霉引起的暗色丝孢霉病，分别用伏立康唑和特比萘芬进行了治疗。在确定病原体种类或抗真菌药敏性之前，我们的病例通过经验性治疗获得了成功。我们总结了日本32例由外瓶霉属引起的皮肤和皮下暗色丝孢霉病病例。患者接受了抗真菌药物治疗，包括伊曲康唑、特比萘芬、伏立康唑和伏立康唑，这些单一疗法的治疗成功率分别为77%（17/22）、67%（8/12）、100%（5/5）和50%（1/2）。尽管广谱唑类抗真菌药伊曲康唑是治疗的首选，但每天125毫克的特比萘芬可能具有相同的疗效。伏立康唑是一种新型广谱唑类药物，是Cyp3A4的中度抑制剂，与伊曲康唑和伏立康唑相比，其药物相互作用较少，表明是治疗这种疾病的一种有前景的药物。
