Scedosporium apiospermum soft tissue infection successfully treated with voriconazole: potential pitfalls in the transition from intravenous to oral therapy

Abstract

An immunocompromised patient with an invasive soft tissue infection due to Scedosporium apiospermum was successfully treated with voriconazole and surgical debridement. After transition from intravenous to oral therapy, successive adjustments of the oral dose were required to achieve complete resolution. For soft tissue infections due to molds characterized by thin, septate hyphae branching at acute angles, voriconazole should be considered a first-line antifungal agent. The potential usefulness of plasma voriconazole levels for guiding optimal therapy should be investigated.

FIG. 1.

Left hand (A) and arm (B) of patient 1 week after transition from intravenous to oral voriconazole. The nodules and pustules form a pattern characteristic of lymphangitic spread. At 2 weeks after reinstitution of intravenous voriconazole therapy, the purulent nodules had disappeared from the hand (C) and arm (D).

FIG. 2.

Histopathologic sections demonstrating the similarity between S. apiospermum (A) and A. fumigatus (B) in autopsy sections of cerebral tissues from immunosuppressed patients (Gomori-methenamine silver stain, ×600 magnification). Both fungi display thin, delicate, septate hyphae branching at acute angles. Note that these sections are provided for illustrative purposes and are not from the patient discussed in this case report.