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Verrucous Nodules on the Toes of a Renal Transplant Recipient—Diagnosis

Arch Dermatol. 2007;143(5):653-658. doi:10.1001/archderm.143.5.653-e.
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Larone  DH Thermally dimorphic fungi. Medically Important Fungi: A Guide to Identification. 3rd ed. Washington, DC ASM Press1995;91- 102
Klein  BSVergeront  JMWeeks  RJ  et al.  Isolation of Blastomyces dermatitidis in soil associated with a large outbreak of blastomycosis in Wisconsin. N Engl J Med 1986;314529- 534
PubMed Link to Article[[XSLOpenURL/10.1056/NEJM198602273140901]]
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PubMed Link to Article[[XSLOpenURL/10.1086/313750]]
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Figure 3.

The patient was treated with oral fluconazole, without improvement. Topical 5% imiquimod cream was added to alternate-day therapy with topical 1% naftifine hydrochloride cream, also without improvement. Owing to the patient's status as an immunosuppressed renal transplant recipient who was receiving hemodialysis, itraconazole and amphotericin B were not prescribed because of the risk of nephrotoxicity and interaction with current medications. However, a trial of liposomal amphotericin B (4 mg every 2 weeks for 6 weeks) was initiated with intralesional injections into the first and second phalanges. The lesions that were injected eventually softened and crusted, with gradual regression in size.

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