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Nov 2011

Paronychia and Necrotic Nodules —Diagnosis

Author Affiliations
 

SECTION EDITOR: MARY S. STONE, MD; ASSISTANT SECTION EDITORS: SOON BAHRAMI, MD; CARRIE ANN R. CUSACK, MD; SENAIT W. DYSON, MD; MOLLY A. HINSHAW, MD; ARNI K. KRISTJANSSON, MD

Arch Dermatol. 2011;147(11):1317-1322. doi:10.1001/archdermatol.2011.324-b

Microscopic examination revealed septate hyaline hyphae, branching at acute angles, invading blood vessel walls (Figure 3). The results of a 1,3 β-D-glucan assay were positive, while those of the galactomannan assay were negative. Tissue cultures yielded Fusarium species, confirming the diagnosis of DF.

The patient was initially on a prophylactic regimen of voriconazole when the cutaneous lesions appeared, and her medication was subsequently changed to posaconazole. However, because new lesions continued to develop, intravenous voriconazole, amphotericin B, and, eventually, terbinafine hydrochloride were added to her antifungal therapy. She was also started on a regimen of filgrastim injections, with improvement in both her neutrophil counts and her cutaneous lesions. Unfortunately, 5 months later, she developed chest pain and shortness of breath. A computed tomographic scan of her chest revealed multiple aortic aneurysms, which were attributed to mycotic vasa vasorum infarcts, and a pericardial effusion due to aneurysm leakage, which was complicated by persistent thrombocytopenia. She was not considered a candidate for surgical repair of the aortic aneurysms and died 1 month later of a suspected aortic rupture.

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