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Voriconazole induced conjunctivitis
Voriconazole induced conjunctivitis

Patient JS (age 53) has chronic cavitary pulmonary aspergillosis and failed itraconazole therapy. After taking voriconazole for several months she relatively suddenly developed florid conjunctivitis which is attributable to voriconazole. This occurred without facial erythema, which is unusual. Voriconazole has been continued.

Voriconazole induced photosensitivity
Voriconazole induced photosensitivity

This man with immunocompromised with autoimmune disease developed bilateral invasive aspergillosis and a galactomannan antigen OD in BAL of 9.0. He was started on voriconazole and responded well. Some weeks later his face became erythematous and slightly uncomfortable. The photographs show the remarkable extent of his voriconazole photosensitivity with very little conjunctivitis or cheilitis (lip dryness). Monochromator testing to narrow band UVB, UVA and visible light and provocation testing was within normal limits. Voriconazole was stopped after 9 months of therapy and reduction of immunosuppression, with resolution of photosensitivity.

Voriconazole induced photosensitivity
Voriconazole induced photosensitivity

This man with immunocompromised with autoimmune disease developed bilateral invasive aspergillosis and a galactomannan antigen OD in BAL of 9.0. He was started on voriconazole and responded well. Some weeks later his face became erythematous and slightly uncomfortable. The photographs show the remarkable extent of his voriconazole photosensitivity with very little conjunctivitis or cheilitis (lip dryness). Monochromator testing to narrow band UVB, UVA and visible light and provocation testing was within normal limits. Voriconazole was stopped after 9 months of therapy and reduction of immunosuppression, with resolution of photosensitivity.

ABPA with severe facial photosensitive rash on voriconazole, Pt RT ( Feb 2011) This 55 year old man with asthma, ABPA, severe bronchiectasis and lung fibrosis was treated with voriconazole, starting in June 2010. He had developed increasing dyspnoea on itraconazole for over 7 years, and his total IgE remained at 1100 KIU/L. He read more... , ,
, , ABPA with severe facial photosensitive rash on voriconazole, Pt RT ( Feb 2011) This 55 year old man with asthma, ABPA, severe bronchiectasis and lung fibrosis was treated with voriconazole, starting in June 2010. He had developed increasing dyspnoea on itraconazole for over 7 years, and his total IgE remained at 1100 KIU/L. He read more...
Facial erythema and eye redness Facial erythema
Facial erythema and eye redness Facial erythema <p>This patient with chronic pulmonary aspergillosis failed itraconazole and was treated with oral voriconazole. She developed facial erythema with remarkable redness of her eyes. She had a sensation of mild irritation of the eyes. Voriconazole treatment was continued.</p>
FEV1 spirometry Image B
FEV1 spirometry Image B
Patient BC
A petite women in her 50’s with severe asthma and fungal sensitization (SAFS) had been unable to tolerate either itraconazole or voriconazole for any length of time, and was severely disabled with her symptoms. One treatment option which is occasionally helpful is to give nebulised amphotericin B (link to video of Helen). She was given 10mg of amphotericin B deoxycholate in water through a Pari LC nebulizer, supervised by a senior physiotherapist. Shortly after starting this, she felt much more breathless and the nebulizer was stopped. Salbutamol rescue was administered. After about 40 minutes she recovered.
 
The spirometer readings show a starting FEV1 of 2.35 L/sec. This fell to 1.05 L/sec, a dramatic fall with amphotericin B nebulisation. (Image A) She recovered with salbutamol to 2.25 L/sec. (Image B)
FEV1 spirometry Image A
FEV1 spirometry Image A
Patient BC
A petite women in her 50’s with severe asthma and fungal sensitization (SAFS) had been unable to tolerate either itraconazole or voriconazole for any length of time, and was severely disabled with her symptoms. One treatment option which is occasionally helpful is to give nebulised amphotericin B (link to video of Helen). She was given 10mg of amphotericin B deoxycholate in water through a Pari LC nebulizer, supervised by a senior physiotherapist. Shortly after starting this, she felt much more breathless and the nebulizer was stopped. Salbutamol rescue was administered. After about 40 minutes she recovered.
 
The spirometer readings show a starting FEV1 of 2.35 L/sec. This fell to 1.05 L/sec, a dramatic fall with amphotericin B nebulisation. (Image A) She recovered with salbutamol to 2.25 L/sec. (Image B)
Aspergillus ear rot and storage mould Aspergillus flavus and Aspergillus parasiticus can produce aflatoxins are generally known as storage fungi, but they can also cause ear rots in the field. These species are observed as a gray-green, powdery molds and they can be detected in corn read more...
Aspergillus ear rot and storage mould Aspergillus flavus and Aspergillus parasiticus can produce aflatoxins are generally known as storage fungi, but they can also cause ear rots in the field. These species are observed as a gray-green, powdery molds and they can be detected in corn read more...
Intestinal aspergillosis Histopathology of the jejenum showing necrosis and hyphae consistent with Aspergillus
Intestinal aspergillosis Histopathology of the jejenum showing necrosis and hyphae consistent with Aspergillus
Intestinal aspergillosis Perforation of intestine - luminal surface
Intestinal aspergillosis Perforation of intestine - luminal surface
Intestinal aspergillosis Perforation of intestine - serosal surface
Intestinal aspergillosis Perforation of intestine - serosal surface
Intestinal aspergillosis A CT scan showing intestinal aspergillosis
Intestinal aspergillosis A CT scan showing intestinal aspergillosis
Valve endocarditis Further image detailsImage A. Multiple small lesions at both ends of the cordae tendinae in this patient who died of disseminated aspergillosis. He was a previously well 70 year old man who developed pneumonia on holiday, required artificial read more... Image A. Mitral valve endocarditis, pt DB., Image B. Aortic valve endocarditis, pt DB. , Image C. Mitral valve endocarditis, pt DB
Image A. Mitral valve endocarditis, pt DB., Image B. Aortic valve endocarditis, pt DB. , Image C. Mitral valve endocarditis, pt DB Valve endocarditis Further image detailsImage A. Multiple small lesions at both ends of the cordae tendinae in this patient who died of disseminated aspergillosis. He was a previously well 70 year old man who developed pneumonia on holiday, required artificial read more...
Pt LA Preterm neonate with primary cutaneous aspergillosis, successful treatment with posaconazole. The patient was a 610 g twin male born by spontaneous normal vaginal delivery at 23 weeks and 4 days gestation. He was started on benzyl penicillin and gentamicin for sepsis. On day 3, he developed metabolic acidosis, hyponatremia, anemia, read more... Image A . Multiple circular papules with white eschars on the back., Image B. Wet mount microscopy of a skin scrape showing fungal fruiting head- suggestive of Aspergillus species
Image A . Multiple circular papules with white eschars on the back., Image B. Wet mount microscopy of a skin scrape showing fungal fruiting head- suggestive of Aspergillus species Pt LA Preterm neonate with primary cutaneous aspergillosis, successful treatment with posaconazole. The patient was a 610 g twin male born by spontaneous normal vaginal delivery at 23 weeks and 4 days gestation. He was started on benzyl penicillin and gentamicin for sepsis. On day 3, he developed metabolic acidosis, hyponatremia, anemia, read more...
Aspergillus ochraceopetaliformis onychomycosis Scanning electron micrograph of Aspergillus ochraceopetaliformis conidial heads
Aspergillus ochraceopetaliformis onychomycosis Scanning electron micrograph of Aspergillus ochraceopetaliformis conidial heads

Aspergillus ochraceopetaliformis in culture and identified in a case of onychomycosis

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