Successful treatment of lymphocutaneous sporotrichosis with fosravuconazole
Abstract
Fosravuconazole is a novel oral antifungal drug developed in Japan that has been used to treat tinea unguium since 2018. It has excellent oral absorbability, and systemic bioavailability has enhanced its efficacy.1 There are no contraindications due to mild CYP450 inhibition, which helps reduce polypharmacy effects. Potassium iodide is the first-line treatment in Japan, while itraconazole is the global standard treatment.2 We report the first case of lymphocutaneous sporotrichosis treated with fosravuconazole, prescribed due to concomitant onychomycosis. A 60-year-old male former office worker with a history of hypertension developed progressive nodular lesions following a scratch from his pet cat 3 months previously. His cat is a healthy cat that never goes outside. Initially misdiagnosed as a bacterial infection, his condition worsened despite antibiotics, with new nodules appearing on the forearm. A physical examination revealed a 25 × 35-mm ulcerated nodule with crusts on the right hand (Figure 1a), two 8-mm subcutaneous masses on the mid-forearm, and a 10 × 8-mm erythematous nodule near the elbow (Figure 1b). The lesions were painless. Although direct microscopic examination of the lesions with KOH was negative, periodic acid-Schiff (PAS) staining of crust smears revealed fungal hyphae with germinated spores. Histopathology revealed granulomatous inflammation with PAS-positive spores in the dermis, confirming lymphocutaneous sporotrichosis (Figure 1c). Plate culture on…
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