Paecilomyces Lilacinus Cutaneous Infection And Treatment Of Combination Of Oral Terbinafine With 5-aminolevulinic Acid Photodynamic

Paecilomyces lilacinus is a kind of opportunistic fungi which can produce serious infections in immunocompromised patients following surgical procedures, trauma inculations, clinical implants or incontaminated materials used clinically. However, in recent years, the incidence of infections in immunocompetent hosts has been increasing. Documented Paecilomyces infections in such patients caused keratitis, cutaneous and subcutaneous infections, onychomycosis, catheterrelated fungemia, pneumonia, peritonitis, osteomyelitis, bursitis and prosthetic-valve endocarditis. Cutaneous and sub-cutaneous infections usually appear insidiously and can manifest with a wide range of clinical features. Diagnosis of P.lilacinus infection is based on clinical manifestations, culture of the fungus and histological features of the lesions. Molecular technique can also be applied. The fungus generally shows a poor response to conventional antifungal drugs, and there has no satisfying therapy been reported. In this article, a case of skin infection of Paecilomyces lilacinus is presented which was diagnosed by culture of the fungus, histopathology of the lesions and molecular technique. According to the in vitro activity, we chose terbinafine 250 mg once a day combined with photodynamic therapy of 5-aminolevulinic acid irradiation (ALA-PDT) and got a satisfying outcome. In addition,49 cases of P.lilacinus skin and soft tissue infections previously reported in the literature are reviewed, to highlight a more optimal therapy for this disease.