Efficacy of Azoles Antifungals in Treatment of Pityriasis Versicolor

Introduction: Pityriasis versicolor is superficial fungal infection. Topical drugs are often effective in treatment of limited disease while systemic drugs are more suitable in extensive cases. The systemic triazole drugs, itraconazole and fluconazole have shown promising results at different doses. Aims: To assess the efficacy and safety of oral fluconazole combined with ketoconazole shampoo and oral itraconazole in the treatment of Pityriasis versicolor. Methods: The study was conducted at department of Dermatology at Nepalgunj Medical College from March 2019 to February 2020. Total 100 patients of both genders with Pityriasis versicolor were randomly allocated into two groups with 50 patients in each group. Patients in Group I received oral fluconazole 300mg a week for two consecutive weeks along with ketoconazole 2% shampoo twice weekly for two weeks while those in Group II received itraconazole 200mg daily for one week. Efficacy was assessed in terms of negative fungal hyphae. The drug is considered safe if no patients were withdrawn for clinical adverse effects or laboratory abnormalities. Results: In this study age ranged from 18 to 50 years with mean age of 31.1 years in Group I and 31.92 years in Group II. Efficacy was seen in 78% of Group I patients as compared to 54% in Group II patients at two weeks and 94% in Group I and 90% in Group II at four weeks. No significant adverse effects were reported in any of the group. Conclusion: Fluconazole along with ketoconazole shampoo is more effective than itraconazole in treatment of pityriasis versicolor with minimal side effects, at lesser cost.

A Case of Successful Endovascular Aortic Repair of Primary Aortoenteric Fistula Without Aortic Explantation

Purpose: The objective of this study is to report a case of a primary aortoenteric fistula successfully treated with endovascular repair without aortic explant. Case Report: A 48-year-old man presented with a 24-hour history of hematemesis and malena. A computed tomography (CT) abdomen and pelvis demonstrated a 6 cm infrarenal aortic aneurysm with periaortic stranding and contrast enhancement within the lumen of the third part of the duodenum. The patient underwent emergency Endovascular Aortic Repair (EVAR). The patient was discharged on day 8 of his admission on oral antibiotics. He returned 7 weeks postindex procedure and underwent a laparotomy with omental patch repair of the aortic defect. Intraoperative cultures grew candida albicans, and the patient was discharged on lifelong oral Fluconazole and Amoxycillin-Clavulanic Acid. At 18 months postoperatively, the patient was clinically stable with improved appearances on CT aortogram. Conclusion: We discuss the use of EVAR without aortic explant as a possible treatment option in the management of patient with primary aortoenteric fistulae. This may potentially avoid the significant morbidity and mortality associated with aortic explant in suitable candidates without perioperative signs of sepsis.

Candida Endophthalmitis Treated Successfully with Isavuconazole - A Case Report

Candida endophthalmitis is a serious complication of candidemia. Diagnosis requires identification of ocular lesions on dilated fundoscopy, aided by isolation of the organism from blood and/or vitreous humor. However, the initial ophthalmological examination may be negative in some cases. Experience with isavuconazole for the treatment of Candida endophthalmitis is limited. We present a case of a 65-year-old woman with metastatic breast cancer on chemotherapy who developed Candida dubliniensis endophthalmitis with initial negative ophthalmological examination. She was treated with vitrectomy and 6 weeks of oral fluconazole. Despite vitrectomy and culture-directed antifungal treatment, management was complicated by lack of response to fluconazole and intolerance to other antifungals, necessitating the use of isavuconazole, which proved efficacious.

Clinical manifestation and initial treatment on infectious respiratory illnesses in HIV-infected patient: a case report

Respiratory illnesses are common complication during the evolution of the disease in HIV-infected patients, mainly of infectious aetiology. Pneumocystis Pneumonia (PCP) is currently the most frequent cause of pulmonary infections in HIV patients, followed by bacterial pneumonia and TB. In this case report involves a 28 years-old male patient with HIV infection presented to the hospital with progressive dyspnoea, fever, non-productive cough and weight loss. Physical examination showed a decreased of oxygen saturation, oral thrush, and respiratory crackles in both lungs. The results of chest x-ray examination suggested a picture of pneumonia. The sputum was examined with Xpert MTB-RIF Assay and the results were negative. This patient was treated with cotrimoxazole in 2 double-strength (DS) tablets three times daily, dual therapy antibiotics combination with a beta-lactam and macrolide, oral fluconazole, also adjuvant corticosteroid of methylprednisolone. This initial treatment based on drug of choice for infectious respiratory illnesses in HIV-infected patient.

Case Report: An Atypical Erysipeloid Presentation of Cutaneous Leishmaniasis from the Hilly Region of Nepal

Cutaneous leishmaniasis, which is the most common form of leishmaniasis, classically presents as small erythematous papules and nodules that develop into ulcers with indurated, raised outer borders. However, lesions of cutaneous leishmaniasis can have pleomorphic and atypical presentations. The erysipeloid form is one of the rare, atypical presentations of cutaneous leishmaniasis. Reported is a case of a 58-year-old man from the hilly region of Nepal who presented with an atypical erythematous and edematous plaque over the left antecubital fossa. Cutaneous leishmaniasis was not considered as an initial diagnosis because of the atypical appearance of the lesion as well as his residence in the hilly region of Nepal. The diagnosis was made after detection of amastigotes on histopathological examination of a cutaneous biopsy specimen. There was complete regression of the lesion after treatment with oral miltefosine followed by oral fluconazole. Clinicians should be aware of atypical presentations of cutaneous leishmaniasis and it should be considered in the differential diagnosis, regardless of the presentation or geographic location.

Refractory dermatitis contributed by pityriasis versicolor: a case report

Background Dermatologic toxicity is a very common immune-related adverse event (irAE) for patients with melanoma who are receiving immune checkpoint inhibitor therapy (ICI). Concurrent skin infection, such as in the case of pityriasis versicolor reported here, can mimic and/or exacerbate dermatologic toxicity from irAE. Case presentation A 58-year-old Caucasian man with a history of pityriasis versicolor infection and metastatic melanoma received ICI therapy. He developed progressively worsening pruritic maculopapular lesions 22 weeks into his treatment that ultimately covered 40% of his body. He was diagnosed with dermatologic toxicity due to ICI therapy with concurrent pityriasis versicolor. He was initially started on topical steroid and topical antifungal cream but achieved minimum improvement. His treatment was then escalated to oral prednisone, but it only achieved modest control of his dermatitis. All subsequent attempts to wean him from oral prednisone resulted in worsening of his dermatitis. Eventually he was started on oral fluconazole in combination with prednisone, which led to rapid resolution of his dermatitis. Conclusion We report a case of dermatological toxicity due to an irAE with concurrent pityriasis versicolor. The steroid treatment for irAE was likely exacerbating the underlying fungal infection, and the fungal infection was in term mimicking the symptoms of irAE. This patient’s severe dermatitis was only brought under control after receiving a more potent antifungal therapy in combination with a steroid. It is vital to look beyond the irAE when managing dermatitis in patients receiving ICI therapy.

COMPARATIVE EFFICACY OF A AND B IN PITYRIASIS VERSICOLOR

Objective: To compare the efficacy of oral fluconazole and oral itraconazole in the treatment of Pityriasisversicolor. Study Design: Comparative prospective study. Methodology: Total 72 patients of both genders with Pityriasis versicolor were included. Patients were randomly allocated into two treatment groups with 36 patients in each group: group A and group B by lottery method. Patients in group A received Cap Fluconazole 150 mg bi- weekly for two consecutive weeks while those in group B received two doses of 400 mg of itraconazole once weekly for two weeks. Patients were asked to follow-up after 4 weeks skin scrapings for microscopy using 10% KOH mount was done at follow-up. Efficacy was assessed in terms of negative fungal hyphae on microscopy. Results: In this study, age ranged from 18 to 40 years with mean age of 33.52 ± 4.12 years in group A, whereas35.055 ± 4.18 years in group B. Mean duration of disease was 4.66 ± 1.51 months in group A and 5.27 ± 1.70months in group B. Efficacy was seen in 77.8% of group A patients as compared to 50% in group B patients(p=0.014). Conclusion: Oral Fluconazole two doses of 150 mg/week (total 300mg/week) for two consecutive weeks wasfound more effective than oral itraconazole.