Use of Voriconazole for the Treatment of Paecilomyces lilacinus Cutaneous Infections: Case Presentation and Review of Published Literature

Abstract

The fungus Paecilomyces lilacinus is a rare but emerging pathogen that causes severe human infections, especially in immunocompromised hosts. It is an important organism to identify due to its poor susceptibility to conventional antifungal drugs, including amphotericin B, itraconazole, and fluconazole. Oculomycosis and cutaneous infections are the two most common manifestations of P. lilacinus infections. Voriconazole has been used successfully to treat P. lilacinus endophthalmitis, but reports of skin and soft tissue infections treated with voriconazole are limited to six prior publications. Our immunocompromised patient had a subcutaneous P. lilacinus infection successfully treated with 3 months of voriconazole therapy.

Benzotriazole: An overview on its versatile biological behavior

“…Indeed, the triazolic system can be replaced by a benzotriazole ring, in order to evaluate the effects of the bioisosteric replacement on the biological behavior. Concerning the mechanism of action, it is known that antimycotic drugs, such as fluconazole [66], itraconazole [67], voriconazole [68], ravuconazole [69] and posaconazole [70] exert their pharmacological action by inhibiting the fungal 14 a-demethylase cytochrome P450. Known as CYP51, this is an essential enzyme in the biosynthesis of sterols.…”

Subcutaneous hyalohyphomycosis due to Purpureocillium lilacinum in an immunocompromised patient after renal transplantation

“…Toshio DEMITSU, 1 Kazutaka NAGASHIMA, 1 Taro OKABE, 2 Yuji MORISAWA, 2 Nobuo ISHIKAWA, 3 Takashi YAGISAWA, 3 Hirotaka FUKUTA, 4 Mamitaro OHTSUKI, 4 Rui KANO, 5 Kazutoshi HARADA 6…”

“…1 P. lilacinum is an airborne and soil fungi with little virulence and may affect immunocompromised hosts causing cutaneous deep mycosis as well as oculomycosis. 1,3,4 Ezzendin et al 5 suggested the usefulness of the antifungal susceptibility testing. 2 Twelve patients had underlying disorders, which might have caused immunosuppression.…”

“…4 Only the female bee has a stinger and can sting as a form of self-defense when provoked or disturbed. The first is that the causative hymenoptera was a Japanese carpenter bee.…”

“…Several articles described the efficacy of voriconazole treatment alone or in combination with terbinafine in P. lilacinum infection. 1,3,4 Ezzendin et al 5 suggested the usefulness of the antifungal susceptibility testing. We emphasize that antifungal susceptibility assay is necessary in recalcitrant cases.…”