Multiple modality treatment regimen in an aggressive resistant fungal hand infection: A case report

Jeremy W. Pyle, Joseph Holladay, Joseph A. Molnar, Julie S. Martin, Anthony J. DeFranzo

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Cutaneous fungal infections are a rare but significant complication associated with immunocompromised states. Lesions allowed to progress to disseminated fungemia are associated with a near 80% mortality rate. Treatment guidelines aimed at local control are vague, centering on wide local excision with systemic antifungal medications. We present the case of a 3-year-old female who, while receiving induction chemotherapy, developed a progressive Aspergillus flavus infection. Involvement included the distal palm and common and proper neurovascular bundles to two fingers. Initial treatments with serial debridement and topical Dakin's solution were unsuccessful in eliminating this fungal infection. A novel treatment using topical voriconazole mixed with Aquaphor® (Beiersdorf AG; Hamburg, Germany) was compounded in the hospital pharmacy to maintain a moist wound healing environment followed by the use of the Vacuum Assisted Closure (VAC®, Kinetic Concepts, San Antonio, TX). Significant improvement was noted within 4 days with this new dressing regimen. Topical voriconazole therapy followed by VAC allowed progressive healing and eventual closure with a split thickness skin graft. The wound was then durably closed, allowing critical chemotherapy to resume. No evidence of systemic fungemia developed, and her clinical recovery preceded laboratory evidence of immune system recovery. Fungal skin infections can be a threat to both life and limb in immunocompromised patients. The armamentarium available to combat this rare but difficult problem is imperfect. In certain infections not responsive to other therapies, the therapeutic regimen described herein should be considered if wide local excision carries significant functional morbidity.

Original languageEnglish (US)
Pages (from-to)318-321
Number of pages4
JournalHand
Volume5
Issue number3
DOIs
StatePublished - Jan 12 2010

Fingerprint

Mycoses
Hand
Fungemia
Skin
Therapeutics
Negative-Pressure Wound Therapy
Aspergillus flavus
Induction Chemotherapy
Immunocompromised Host
Debridement
Bandages
Infection
Wound Healing
Fingers
Germany
Immune System
Extremities
Guidelines
Morbidity
Transplants

Keywords

  • Aspergillus
  • Fungal
  • Fungus
  • Hand infection
  • Voriconazole

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Multiple modality treatment regimen in an aggressive resistant fungal hand infection : A case report. / Pyle, Jeremy W.; Holladay, Joseph; Molnar, Joseph A.; Martin, Julie S.; DeFranzo, Anthony J.

In: Hand, Vol. 5, No. 3, 12.01.2010, p. 318-321.

Research output: Contribution to journalArticle

Pyle, Jeremy W. ; Holladay, Joseph ; Molnar, Joseph A. ; Martin, Julie S. ; DeFranzo, Anthony J. / Multiple modality treatment regimen in an aggressive resistant fungal hand infection : A case report. In: Hand. 2010 ; Vol. 5, No. 3. pp. 318-321.
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