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Eur Respir J 2008; 32:528-529
Copyright ©ERS Journals Ltd 2008
doi: 10.1183/09031936.00024508

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Improvement with long-term itraconazole therapy for Fonsecaea pedrosoi-related mediastinal phaeohyphomycosis

N. Singh, R. Agarwal and D. Gupta

Dept of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

To the Editors:

In the September 2006 issue of the European Respiratory Journal, we reported the first culture-proven case of mediastinal mass due to Fonsecaea pedrosoi that had been successfully managed medically 1. Maintenance therapy with oral itraconazole 100 mg b.i.d. was continued for a total of 3 yrs. This decision was taken in view of the rarity of the disease, paucity of data on the management of such cases and good clinico-radiological response to 6 months of therapy with this antifungal agent.

During this time period, the patient continued to experience clinical improvement, in the form of complete resolution of the dyspnoea and dysphagia that had mandated tracheostomy and feeding jejunostomy, respectively, at the time of initial presentation. Hoarseness of voice had also improved significantly with speech therapy. The patient is now able to carry out all activities of daily living and has restarted his professional work. The patient was assessed with repeat computed tomography (CT) scans of the thorax at 1-yr intervals. A significant regression in the size of the mediastinal mass was also observed on CT (fig. 1Go). In view of the patient’s clinical and radiological stability, itraconazole treatment has now been stopped and a close follow-up planned.


Figure 1
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  		Fig. 1— a, c) The pre-treatment (baseline) images obtained at the level just below the thoracic inlet and those at the level of aortic arch. b, d) Post-treatment images. A substantial reduction in the size of the mediastinal mass can be seen.

 
The authors' aim behind this communication is only to stress the fact that long-term itraconazole therapy may help to achieve sustained improvement followed by stability in both clinical symptoms and radiological lesions of patients with this rare entity.

Statement of interest

None declared.

REFERENCES

  1. Singh N, Agarwal R, Gupta D, Shivaprakash MR, Chakrabarti A. An unusual case of mediastinal mass due to Fonsecaea pedrosoi. Eur Respir J 2006;28:662–664.[Abstract/Free Full Text]




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