Date: 26 November 2013
Facial erythema: Voriconazole rash in ABPA patient resistant to corticosteroids, treated with voriconazole 200mg BID. Serum voriconazole levels were very low and the dose was raised to 250mg BID. Within 3 weeks patient had developed remarkable facial erythema. His trough voriconazole concentration at this time was 370ng/ml. When voriconazole was stopped because of the facial erythema and lack of impact on his ABPA his facial erythema resolved over 4 weeks.
Forearm erythema related to voriconazole. As with facial erythema patient developed remarkable forearm erythema with lesions similar to porphyria cutanea tarda all of which resolved with stopping voriconazole.
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Notes:
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BAL specimen showing hyaline, septate hyphae consistent with Aspergillus, stained with Blankophor
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Mucous plug examined by light microscopy with KOH, showing a network of hyaline branching hyphae typical of Aspergillus, from a patient with ABPA.
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Corneal scraping stained with lactophenol cotton blue showing beaded septate hyphae not typical of either Fusarium spp or Aspergillus spp, being more consistent with a dematiceous (ie brown coloured) fungus
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Corneal scrape with lactophenol cotton blue shows separate hyphae with Fusarium spp or Aspergillus spp.
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A filamentous fungus in the CSF of a patient with meningitis that grew Candida albicans in culture subsequently.
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Transmission electron micrograph of a C. neoformans cell seen in CSF in an AIDS patients with remarkably little capsule present. These cells may be mistaken for lymphocytes.
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India ink preparation of CSF showing multiple yeasts with large capsules, and narrow buds to smaller daughter cells, typical of C. neoformans
