Successful treatment of subcutaneous Purpureocillium lilacinum infection with fosravuconazole
Abstract
Purpureocillium lilacinum, formerly known as Paecilomyces lilacinus, is a filamentous fungus that is widely distributed in soils and other environments. This fungus causes ocular infections, such as keratitis, and opportunistic infections, mainly in immunocompromised individuals. Because of its rarity (only around 20 cases have been reported in Japan), evidence-based treatment has not yet been established for P. lilacinum infections. Here, we report a case study of a patient on immunosuppressive therapy who presented with multiple subcutaneous nodules caused by P. lilacinum, which we successfully treated with fosravuconazole. The patient, a 77-year-old man, had noticed the nodules on his right lower limb 2 weeks prior to presenting at our hospital. He had no history of trauma, nor did he practice gardening. He had been diagnosed 2 years earlier with myasthenia gravis, which was treated with prednisolone 5 mg/day and tacrolimus 2 mg/day; his condition was complicated by diabetes mellitus. He presented with seven subcutaneous nodules on his right lower limb, with some nodules exhibiting crusting on the surface (Figure 1a). Direct microscopy of the crusting revealed fungal hyphae (Figure 1b). He also had tinea pedis and tinea unguium. Two nodules on the lower limb were excised and subjected to various tests. Histological examination revealed the formation of subcutaneous granulomas, within which were numerous giant cells and fungal components (Figure 1c–f). The fungal culture…
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