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Perivascular lymphocytic dermatitis: case report A 51-year-old man developed perivascular lymphocytic dermatitis following antifungal treatment with fluconazole and isavuconazole [not all routes stated; dosages not stated]. The man, who had chronic kidney disease and cardiac sarcoidosis presented with a rash after outpatient initiation of fluconazole for pulmonary cryptococcosis. He had developed erythematous and pruritic lesions on bilateral thighs after two doses of fluconazole. The rash spread to trunk, lower legs and arms over the next few days. Skin biopsy revealed perivascular lymphocytic dermatitis. The man’s treatment with with fluconazole discontinued and the rash resolved. Oral challenge with isavuconazole, resulted in rash recurrence. He had also developed nephrotoxicity due to amphotericin-B. He subsequently started receiving treatment with posaconazole without adverse effects [duration of treatments to reaction onset not stated]. Author comment: "This is the first reported case to our knowledge of a patient safely tolerating posaconazole in a graded manner after developing reactions to both fluconazole and isavuconazole." Patel A, et al. TRIAZOLE DRUG ALLERGY: SUCCESSFUL TOLERATION OF POSACONAZOLE AFTER REACTIONS TO FLUCONAZOLE AND ISAVUCONAZOLE. Annals of Allergy, Asthma and Immunology 123 (Suppl.): 803431898 S69, Nov 2019 [abstract] - USA

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Reactions 9 Nov 2019 No. 1778