Therapeutic Use of Posaconazole for Cutaneous Purpureocillium lilacinum Infection Refractory to Itraconazole

Purpureocillium lilacinum is a saprophytic fungus with a ubiquitous environmental distribution. Unfortunately, no standard treatment has yet been established for cutaneous P. lilacinum infections. Based on the in vitro antifungal susceptibility test, posaconazole has been considered an effective treatment option. We herein present a case involving a 72-year-old woman who visited our clinic due to a peripherally spreading, well-demarcated, asymptomatic, scaly, and erythematous patch on her forehead that had persisted for 4 months. She had been diagnosed with cutaneous P. lilacinum infection and had been treated with itraconazole (200 mg/day). However, the lesion recurred in the same area. Histopathological findings revealed suppurative granulomatous dermatitis with fungal elements. Fungal culture confirmed P. lilacinum regrowth. Posaconazole was selected to treat the recurrence of P. lilacinum infection. After 10 weeks of treatment, the lesion decreased dramatically without any adverse drug events. We recommend posaconazole as a treatment option for P. lilacinum infection refractory to itraconazole.