Case Reports
Case Report: I reatment of Blastomycosis with Fluconazole

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ABSTRACT

The authors present two cases of systemic blastomycosis successfully treated with fluconazole. In one case, the disease involved the respiratory tract, and the central nervous system was presumed to be involved. The second case consisted only of pulmonary blastomycosis. Both patients were treated with oral fluconazole 200 mg twice per day for 9 and 6 months, respectively. Treatment with this new triazole antifungal agent resulted in the complete resolution of the disease in both patients. They have remained asymptomatic for more than 6 months after the completion of therapy.

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    Itraconazole has excellent in vitro activity against B dermatitidis, but the CSF levels are very poor. Fluconazole, on the other hand, is not recommended for the treatment of blastomycosis but has excellent penetration into the CSF and has proved effective in treating CNS blastomycosis in a few patients.70 Voriconazole achieves good CSF concentrations and also has excellent activity against the organism.

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    Following initial therapy with amphotericin B, the choice of an oral agent for further therapy is unclear. Itraconazole has poor CNS penetration152 and although fluconazole crosses the blood–brain barrier effectively, clinical failures have been described.131,132,153,154 Voriconazole achieves good penetration into the CNS147 and there have been several reports of successful therapy when used to treat CNS blastomycosis.127,148,149

  • Treatment and experimental therapeutics of blastomycosis

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