P2415Tinea corporis mimicking erythema annulare centrifugum

Eun Jung Kim, PhD, Department of Dermatology, Kangnam St. Mary’s Hospital,Seoul, South Korea; Hei Sung Kim, MD, Department of Dermatology, KangnamSt. Mary’s Hospital, Seoul, South Korea; Hyung Ok Kim, MD, Department ofDermatology, Kangnam St. Mary’s Hospital, Seoul, South Korea; Young Min Park,MD, Department of Dermatology, Kangnam St. Mary’s Hospital, Seoul, SouthKorea

Tinea corporis usually presents as an erythematous annular plaque with a scaly,concentrically expanding border. However, it is often difficult to diagnose when theinitial manifestation is atypical, especially in immunocompromised patients.Because it may mimic other inflammatory dermatologic diseases, it is importantto include fungal infection in the differential diagnoses. Histologic examination maybe of value in establishing a definitive diagnosis for such difficult cases. We hereinreport a case of tinea corporis that presented with skin lesions reminiscent oferythema annulare centrifugum. A 61-year-old Korean female presented withmultiple pruritic lesions on the back for a few days. She had been diagnosed withmultiple myeloma, and was being treated with Velcade chemotherapy. Potassiumhydroxide examination was positive, and on the histologic examination fungalhyphae were noted on periodic acideSchiff stain. Fungal cultures of skin scrapingsshowed a growth of Trichophyton rubrum.

MARCH 2

cial support: None identified.

Commer

P2416Transungual iontophoresis of terbinafine for onychomycosis: Ex vivoevaluation

Anroop Nair, MD, PhD, The University of Mississippi, University, MS, UnitedStates; Hyun Kim, PhD, Transport Pharmaceuticals, Inc, Framingham, MA, UnitedStates; Phillip Friden, PhD, Transport Pharmaceuticals, Inc, Framingham, MA,United States; S. Narasimha Murthy, PhD, The University of Mississippi,University, MS, United States; Shawn Davis, PhD, Transport Pharmaceuticals,Inc, Framingham, MA, United States

Purpose: Treatment of onychomycosis may be facilitated by iontophoresis (ITP),which provides an electrical driving force to move molecules across barriers andmay be useful in enhancing the penetration of drugs across the nail. This studyevaluated the effect of ITP on the transungual delivery of terbinafine (TH) using twoex vivo models.

Method: Iontophoretic delivery of TH was assessed using a ‘‘nail on agarose’’ modelwith human cadaver toe nails and a surrounding ‘‘skin-like’’ barrier membraneplaced on agarose blocks, and separately with intact cadaver toes. The drug wasloaded onto two different applicator designs (contacting nail only or nail andadjacent skin) and delivered using anodal current. The amount of drug loaded in thenail and permeated into the agarose for electrical doses between 2 and 60 mA*minwas determined and compared to passive delivery. In the intact cadaver toe model,10 mA*min was applied and the drug delivered into the nail, nail bed, and thesurrounding tissues was determined by extraction and HPLC.

Results: In the nail on agarose model, the amount of TH permeated through the nailor nail and skin increased linearly with an increase in the electrical dose for bothapplicators, with higher permeation observed using the nail-and-skin applicator(11.9 �g vs 0.73 �g at the 2 mA*min dose) because of the increased ‘‘skin’’ delivery.TH loaded in the nail also increased with increasing electrical dose for bothapplicators and was greater than passive. For the nail-only applicator, the mean drugloads in the nail plate (1 cm2 contact area) and the surrounding nail (~3 cm2) were356 �g/g and 15.3 �g/g, respectively. For the nail-and-skin applicator, the mean drugload was 55 �g/g throughout the whole nail (~4 cm2), yielding a total drug load (THmass) comparable to the nail-only applicator. In the intact cadaver toe model, drugloaded in the nail using the nail-only and nail-and-skin applicator during ITP was154.2 6 48.9 and 44.8 6 5.4 �g/g, respectively. In addition, the nail and skinapplicator further delivered significant amount of TH into the surrounding tissuesand nail bed.

Conclusions: ITP improved TH permeation through and load into the nail, andachieved levels well above the MIC of terbinafine for dermatophytes (0.003-0.006�g/mL). This may offer a novel treatment option for onychomycosis.

cial support: 100% sponsored by Transport Pharmaceuticals, In

Commer c.

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P2417Microsphaeropsis arundinis: Case report of cutaneous infection

Matthew Hall, Mayo Clinic, Jacksonville, FL, United States; James Keeling, MD,Mayo Clinic, Jacksonville, FL, United States; Lisa Brumble, MD, Mayo Clinic,Jacksonville, FL, United States

Microsphaeropsis arundinis is an anamorphic fungus that typically inhabitsterrestrial plant hosts and is ubiquitous in soil and fresh water. It is a member ofthe class Coelomycetes, which is emerging as a pathogen causing soft tissueinfections in immunocompromised patients. Such infections most commonly arisesecondary to traumatic inoculation which may progress and spread subcutaneously.Two case reports of soft tissue infections have been previously described inAustralia, but infections with this organism have not yet been described in theUnited States. We report a case of cutaneous M arundinis infection. The patient wasa 70-year-old male with a medical history significant for renal transplantation, onchronic immunosuppression consisting of tacrolimus, mycophenolate mofetil, andprednisone. He initially presented with a 1-month history of a shiny, keratotic plaqueon the dorsal surface of the middle finger. A shave biopsy was interpreted assquamous cell carcinoma, and the lesion was treated by Mohs surgery. Hesubsequently developed papules at the excision site and proximally on the forearm.The papule on the forearm was excised and fungal hyphae were noted on a periodicacideSchiff stain of the pathology specimen. On fungal culture, M arundinis wasisolated. The patient was treated with a 6-month course of posaconazole withresolution of the lesions. To our knowledge, this is the first reported case ofcutaneous M arundinis infection in the United States.

cial support: None identified.

Commer

P2418A case of alternariosis in a renal transplant patient

Divya Srivastava, MD, Henry Ford Health System, Detroit, MI, United States;Henry Lim, MD, Henry Ford Health System, Detroit, MI, United States; Holly Kerr,MD, Henry Ford Health System, Detroit, MI, United States

Alternariosis is a rare phaeohyphomycotic infection that is increasingly prevalent inimmunosuppressed patients, especially solid organ transplant patients. We presenta case of a 58-year-old African American male with end stage renal disease and a1-year history of a renal transplant receiving tacrolimus and azathioprine. Ona hospital admission for acute shortness of breath and mental status changes, he wasfound to have a 3-cm hyperkeratotic plaque on the left tibia. Biopsy showed mixedsuppurative and dermal inflammation and pigmented fungi, confirming phaeohy-phomycosis. Tissue culture confirmed Alternaria alternata. The patient ultimatelysuccumbed to respiratory distress and sepsis caused by bacterial pneumonia despiteaggressive treatment with broad antibiotics and antifungals. While alternariosis wasan incidental finding in this patient, it is an important diagnosis to consider inimmunosuppressed patients because it may be an indication of worsening hostimmune status and may lead to systemic disease. The treatment of choice is surgicalexcision or itraconazole.

cial support: None identified.

Commer

J AM ACAD DERMATOL AB115