Paecilomyces lilacinus infection in a heart transplant recipient and successful treatment with terbinafine
Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America 28(5): 1169-1170
A case is reported in a 48-year-old male heart transplant recipient from the USA who developed a 1.5 cm draining nodule on his right calf in March 1996. Cultures of a biopsy specimen yielded P. lilacinus. Satellite lesions appeared despite therapy with itraconazole capsules. Following susceptibility testing, itraconazole was discontinued and amphotericin B was started. This was ceased due to renal insufficiency and fluconazole was administered. Further leg nodules developed and liposomal amphotericin B was given followed by itraconazole solution. Cure was finally achieved with oral terbinafine (250 mg twice daily). Improvement was noted in the skin lesions within 4 weeks, with complete resolution of the nodules by 12 weeks. Terbinafine caused no adverse side effects.