Management of Paecilomyces lilacinus paecilomycosis: Contribution of susceptibility testing, cure by surgery and voriconazole; [Prise en charge d'un cas de paecilomycose à Paecilomyces lilacinus: Apport de l'antifongigramme, guérison par chirurgie et voriconazole]

A 84-year-old man. treated by prednisone for Horton's disease and an obstructive chronic broncho-pneumonopathy. presented dermo-hypodermitis of the ankle and of left leg. Paecilomyces lilacinus was isolated on several occasions from lesions, and fungal spores and hypha were highlighted in the biopsies, thus affirming the fungal origin of the lesions. An E-test showed that the strain was completely resistant to amphotericin B and itraconazole in vitro. but not to voriconazole. Decreasing daily corticosteroid dose. two surgical operations and 103 days of treatment by voriconazole enabled cure of the cutaneous lesions. Taking into account the great variability of sensitivity of Paecilomyces to antifungal agents, an E-test facilitates treatment of these mycoses, which is often difficult on this type of background.