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December 1969

Local Chemotherapy of Maduromycosis Caused by Monosporium apiospermum

Author Affiliations

Durham, NC

From the departments of medicine (Drs. Buckley and Grant), orthopedic surgery (Drs. Mathews and Edwards), microbiology and immunology (Drs. Buckley and Neilsen), and pathology (Dr. Mathews), Duke University Medical Center, Durham, NC. Dr. Buckley is a Research Career Development Awardee.

Arch Intern Med. 1969;124(6):748-753. doi:10.1001/archinte.1969.00300220100019

Localized deep-seated fungus infections are only occasionally seen in the temperate climate of this country. Infection with Monosporium apiospermum is especially uncommon, but does occur.1 Unlike mycetomatous disease caused by other fungi, infections with M apiospermum respond poorly to chemotherapy.1,2 Destructive excision or amputation of involved tissues is usually necessary.

A patient, who had maduromycosis of the foot caused by M apiospermum but had refused amputation, provided a unique opportunity to evaluate the effectiveness of a new therapeutic approach to localized fungus infection: high dosage, local, parenterally administered chemotherapy. The relative effectiveness and safety of two different antifungal drugs, and the usefulness of dimethyl sulfoxide (DMSO) as a vehicle for local parenterally administered therapy were explored in this patient. The chronicity of the infection and complicating bacterial osteomyelitis precluded eventual salvage of a functional foot. Nevertheless, the studies accomplished confirmed the effectiveness of local parenterally administered therapy and

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