Successful use of posaconazole in a pediatric case of fungal necrotizing fasciitis

OBJECTIVE: To report a pediatric case of posttraumatic fungal fasciitis treated successfully with a combination including posaconazole. DESIGN: Case report. SETTING: Pediatric critical care unit at Antwerp University Hospital. PATIENT: A 12-yr-old female polytrauma patient, suffering from extensive skin and muscle injuries, developed fasciitis. Two fungi (Mucor and Trichosporon species) were isolated. The necrotic tissues were aggressively excised, hyperbaric oxygen therapy was applied, and oral posaconazole was added to the initial amphotericin B treatment. The patient made an excellent recovery. CONCLUSIONS: A combination of a high index of suspicion, early aggressive surgery, hyperbaric oxygen, and the association of amphotericin B and posaconazole led to a successful outcome in a case of fungal necrotizing fasciitis. After decades of disappointing amphotericin B treatment in spite of acceptable in vitro activity, the combination with the new triazole posaconazole seems promising.