Chromoblastomycosis: combined treatment with pulsed itraconazole therapy and liquid nitrogen cryotherapy

Authors


Ranthilaka R. Ranawaka, MD 310/4 Kulasiri Kumarage Mawatha Katuwana, Homagama, Sri Lanka E-mail: ranthilaka37@yahoo.com

Abstract

Background  Three patients with histology- and culture-proven chromoblastomycosis reported to the Colombo South Teaching Hospital, Sri Lanka, in 2005. All three were men (age range, 48–53 years). The duration of symptoms varied from 1 to 8 years and the lesions were on the lower limbs.

Methods  The patients were treated simultaneously with liquid nitrogen cryotherapy and itraconazole pulses, i.e. 200 mg twice daily for 7 days per month, 1 week on and 3 weeks off. Cryotherapy was given every fortnight using large cotton swabs attached to ekels or the cryogun.

Results  Two patients showed a good clinical response within 4 months, with negative histopathology and culture in 4–6 months. The third patient was very resistant to treatment and needed a step-up of the itraconazole dose.

Conclusion  A combination of fortnightly liquid nitrogen cryotherapy and pulsed monthly itraconazole is cost-effective and shortens the duration of therapy compared with the use of itraconazole or cryotherapy alone.

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