Date: 26 November 2013
Secondary metabolites, 3D structure: Trivial name – terretonin
Copyright: n/a
Notes:
Species: A. terreusMolecular formulae: C26H3209Selected references: McIntyre, C.R.; Scott, F.E.; Simpson, T.J.; Trimble, L.A. and Vederas, J.C., Application of Stable Isotope Labelling Methodology to the Biosynthesis of the Mycotoxin, Terretonin, by Aspergillus terreus: Incorporation of 13C Labelled Acetates and Methionine, 2H and 13C, 18O Labelled Ethyl 3,5-Dimethylorsellinate and Oxygen-18 Tetrahedron 1989 45 () 2307-2321 J. P. Springer, J. W. Dorner, R. J. Cole, R. H. Cox Terretonin, a Toxic Compound from Aspergillus terreus J. Org. Chem. 1979 44 () 4852-4854
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After 3 weeks of posaconazole given for chronic pulmonary aspergillosis, patient NC had a remarkable exacerbation of psoriasis. He had had psoriasis for years, with little trouble and almost no treatment. After taking posaconazole 400mg twice daily, he developed psoriatic plaques on his hands for the first time ever. The plaques on his lower legs became confluent. This occurred in association with worsening chest symptoms, notably increased coughing, more breathlessness and increasing oxygen requirement.
Posaconazole was stopped after 3 weeks, and 2 weeks later he was still very symptomatic with his chest. This responded to a 2 week course of corticosteroids, and his psoriasis also improved.
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Patient PC: An example of localised caspofungin rash and phlebitis related to caspofungin infusion.
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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 had marked photopsia (visual hallucinations) and facial erythema in the first 3 weeks of therapy. His trough voriconazole concentration was 1.17 mg/L. Over 3 months, he had minor improvement in his breathlessness but continued facial erythema, despite factor 50 sunblock. After 5 months of therapy his facial rash has altered to show acneiform lesions with localised crusting and background severe erythema. His face effectively crusted over, and he stopped therapy.
Over the next 3 weeks his facial appearance slowly improved .
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