itraconazole / Generic mfg. - LARVOL DELTA

Lymphocutaneous sporotrichosis: A case report from southeastern China and review of the literature. (PubMed, Medicine (Baltimore)) - "This case illustrates that mNGS, as an emerging molecular biological diagnostic technique, holds significant diagnostic value for the rapid identification of sporotrichosis. Timely and accurate diagnosis is essential for achieving favorable clinical outcomes."

Journal • Review • Hematological Disorders

Dermatophytosis beyond Trichophyton indotineae: genomic characterization of rare keratinophilic fungi Myriodontium keratinophilum and Aphanoascus verrucosus in North India. (PubMed, Microbiol Spectr) - "keratinophilum exhibited reduced susceptibility to multiple antifungals, including high minimum inhibitory concentrations (MICs) (>16 mg/L) against griseofulvin and itraconazole. Furthermore, the first-ever genome report of M. keratinophilum and its ab initio functional annotation is useful for further studies and management of opportunistic pathogens that exhibit reduced susceptibility towards itraconazole, the first-line drug of treatment for terbinafine-resistant T. indotineae infections. An early correct molecular identification of the etiologic agents of skin infections is warranted to tackle the new agents of dermatophytosis at the earliest stage."

Journal • Dermatology • Infectious Disease

Consensus recommendations for Trichophyton indotineae: A modified Delphi study. (PubMed, J Eur Acad Dermatol Venereol) - "These consensus statements provide practical interim recommendations. Randomized controlled trials are needed to validate outcomes and optimize regimens."

Journal • Dermatology • Infectious Disease

Antifungal pulse therapy for onychomycosis: a narrative review. (PubMed, Eur J Clin Pharmacol) - "The current evidence supports continuous terbinafine as the preferred first-line systemic treatment for dermatophyte onychomycosis, whereas pulse itraconazole remains an important alternative for patients who are unable to tolerate terbinafine, have contraindications to its use, or have failed previous therapy. Further well-designed randomized studies with standardized outcome measures and long-term assessment of recurrence are required to better define the optimal role of pulse antifungal therapy in onychomycosis management."

Journal • Review • Infectious Disease

Disseminated Histoplasmosis Masquerading as Ampullary Carcinoma in AIDS (ACG 2026) - "Case Description/ A 33-year-old male with perinatally acquired HIV/AIDS (CD4 count 48 cells/µL) and recently diagnosed disseminated histoplasmosis on itraconazole maintenance phase therapy, presented with jaundice, pruritus, and epigastric discomfort...Cholangiography demonstrating common bile duct dilation with distal stricture (C) and intrahepatic biliary duct dilation (D). Figure: Figure 2: Numerous intracellular small round-to-ovoid narrow-based budding yeast forms are highlighted by GMS stain on ampullary biopsy (A) and small bowel resected segment (B)."

Ampulla of Vater Carcinoma • Biliary Cancer • Gastroenterology • Gastrointestinal Disorder • Hepatology • Human Immunodeficiency Virus • Infectious Disease • Oncology • Pruritus • CD4

Colonic EBV-Associated Smooth Muscle Tumor Concurrent With Disseminated Histoplasmosis in Advanced AIDS (ACG 2026) - "In addition, disseminated histoplasmosis was treated by four weeks of liposomal amphotericin B, followed by itraconazole maintenance therapy. Targeted immunohistochemistry with EBV ISH is essential for diagnosis, particularly when concurrent opportunistic infections are present. Figure: Figure 1: Colonoscopy findings: large nodular masses in the ascending colon and cecum with normal terminal ileum."

Metastases • Colorectal Cancer • Cough • Epstein-Barr Virus Infections • Gastroenterology • Gastrointestinal Disorder • Human Immunodeficiency Virus • Infectious Disease • Leiomyosarcoma • Oncology • Respiratory Diseases • Sarcoma • Solid Tumor • CALD • CD4

Talaromyces marneffei Infection Mimicking Refractory Pyoderma Gangrenosum in Ulcerative Colitis on Combination Immunosuppression (ACG 2026) - "Case Description/ A 54-year-old man with severe ulcerative pancolitis on infliximab (10 mg/kg every 8 weeks), 6-mercaptopurine, and mesalamine presented with a progressively enlarging ulcerative lesion on the dorsal left hand one month after travel to Thailand...Initial treatment with topical corticosteroids failed, and immunosuppression was escalated with oral prednisone, high-potency topical clobetasol, topical ruxolitinib, and increased infliximab dosing to every 6 weeks without improvement...The patient was started on oral itraconazole 200 mg twice daily, resulting in rapid and marked clinical improvement...Lack of response to standard PG therapy should prompt early biopsy with microbial cultures, particularly in immunosuppressed patients with relevant travel exposure. To our knowledge, this represents the first reported case of a rare presentation of cutaneous talaromycosis mimicking PG in an IBD patient on biologic therapy."

Gastroenterology • Gastrointestinal Disorder • Immunology • Infectious Disease • Inflammatory Bowel Disease • Pyoderma Gangrenosum • Ulcerative Colitis

Safety and Effectiveness of Infliximab Salvage Therapy for Acute Severe Ulcerative Colitis in a Patient With Active Histoplasmosis: A High-Stakes Dilemma (ACG 2026) - "Infectious disease recommended a 3-day course of amphotericin B followed by long-term itraconazole and noted no contraindications to steroid therapy. Her initial fecal calprotectin ( >8,000 mg/L) and C-reactive protein (CRP) levels (182 ug/g) decreased toward normalization with IV methylprednisolone therapy... We demonstrate the safety and effectiveness of IFX rescue therapy in a young patient with both ASUC and active histoplasmosis. This rescue approach for young patients with concurrent active histoplasmosis should be considered following multidisciplinary consultation between gastroenterologists and infectious disease specialists."

Clinical • Gastroenterology • Gastrointestinal Disorder • Immunology • Infectious Disease • Inflammatory Bowel Disease • Ulcerative Colitis • CRP

Granulomatous Hepatitis and Adrenal Insufficiency Revealing Disseminated Histoplasmosis (ACG 2026) - "Given the electrolyte abnormalities and adrenal enlargement, primary adrenal insufficiency was suspected, and hydrocortisone and fludrocortisone were initiated with clinical improvement. Prompt initiation of itraconazole resulted in normalization of transaminases and clinical improvement, emphasizing the importance of early recognition and targeted antifungal therapy for potentially reversible hepatic injury Figure: CT abdomen demonstrating bilateral adrenal enlargement in the setting of disseminated Histoplasmosis. Figure: Liver biopsy demonstrating granulomatous hepatitis with lobular granulomatous inflammation (H&E stain)."

Cardiovascular • Endocrine Disorders • Fibrosis • Heart Failure • Hepatology • Immunology • Infectious Disease • Inflammation • Liver Failure • Nephrology • Renal Disease

A Mass-Forming Mimic: Gastrointestinal Histoplasmosis Masquerading as Colorectal Malignancy in Advanced HIV (ACG 2026) - "She was diagnosed with GIH and started on amphotericin B with planned itraconazole transition...(C) Rectal mass biopsy with granulomatous inflammation on hematoxylin and eosin stain, 200Ã. (D) Gomori methenamine silver stain highlighting small budding yeasts consistent with H capsulatum in the rectal mass biopsy, 400Ã."

Metastases • Colonic Polyps • Colorectal Cancer • Cytomegalovirus Infection • Gastroenterology • Gastrointestinal Disorder • Human Immunodeficiency Virus • Immunology • Infectious Disease • Inflammatory Bowel Disease • Kaposi Sarcoma • Oncology • Sarcoma • Solid Tumor • CD4 • CD68

A Rare Case of Esophageal Coccidioidomycosis Presenting as Odynophagia (ACG 2026) - "Treatment requires prolonged antifungal therapy with fluconazole or itraconazole for stable disease, while severe or rapidly progressive dissemination warrants amphotericin B until clinical stabilization. Figure: A large fungating mass with no bleeding found in middle third of esophagus, 26 to 35 cm from the incisors Figure: Severe stenosis seen 26 to 35 cm from the incisors due to mass. Stenosis was 6 mm inner diameter, tranversed after downsizing scope."

Clinical • Cough • Gastrointestinal Disorder • Human Immunodeficiency Virus • Infectious Disease • Respiratory Diseases • CD4

Disseminated Histoplasmosis Mimicking Decompensated Cryptogenic Cirrhosis With Portal Hypertension (ACG 2026) - "Case Description/ A 68-year-old woman with rheumatoid arthritis previously treated with abatacept, methotrexate, and hydroxychloroquine and presumed cryptogenic cirrhosis was admitted with markedly elevated liver enzymes and a right frontoparietal subdural hematoma after a ground-level fall...Liposomal amphotericin B was initiated, complicated by SIRS requiring ICU care, then transitioned to oral itraconazole...Figure: Figure 1. Axial CT abdomen demonstrating scattered, small to moderate volume ascites."

Cardiovascular • CNS Disorders • Fibrosis • Gastrointestinal Disorder • Hepatology • Immunology • Infectious Disease • Inflammatory Arthritis • Neuroendocrine Tumor • Portal Hypertension • Rheumatoid Arthritis • Solid Tumor • CHGA

Disseminated Gastrointestinal Histoplasmosis in an Immunocompromised Patient (ACG 2026) - "Case Description/ We present a 31-year-old female with history of spondyl-arthropathy on adalimumab since 2016, herpes simplex virus type 2 on valacyclovir that was admitted for progressive post-prandial abdominal pain, nausea, vomiting, hematochezia, and flu-like symptoms for 3 months...She started enteral itraconazole with trough levels monitored closely...Figure: Axial CT Abdomen/Pelvis view. Visually emphasizes the extent of obstruction seen in patient's case."

Clinical • Gastrointestinal Disorder • Herpes Simplex • Immunology • Infectious Disease • Pneumonia • Respiratory Diseases • Sarcoidosis • Spondylarthritis

Gastrointestinal Involvement of Disseminated Histoplasmosis (ACG 2026) - "His medical history notable for ileocolonic Crohnâs disease on adalimumab with recurrent admissions for GI bleeding...Progressive disseminated histoplasmosis is lethal but with the gold standard of amphotericin B with transition to itraconazole treatment, 80% of cases have good prognosis. However inappropriate therapies including immunosuppressive agents worsen the fungal infection. Figure: Mucosal changes with smooth mucosa and pseudopolyps Figure: Duodenal histoplasmosis histology"

Crohn's disease • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Human Immunodeficiency Virus • Immunology • Infectious Disease • Inflammation • Inflammatory Bowel Disease • Peptic Ulcer

Multifocal Verrucous Esophageal Carcinoma (VEC) Arising in Refractory Candida Esophagitis (ACG 2026) - "Initial antifungal treatments (fluconazole, itraconazole, and micafungin) were unsuccessful in eradicating the infection. Deeper tissue acquisition and multidisciplinary review are critical to establish a diagnosis. Figure: Upper third of the esophagus: stenosis/stricture and polypoid mass Figure: Lower third of the esophagus: mass"

Candidiasis • Diabetes • Esophageal Cancer • Gastrointestinal Disorder • Human Immunodeficiency Virus • Infectious Disease • Metabolic Disorders • Oncology • Squamous Cell Carcinoma

Disseminated Histoplasmosis Masquerading as Decompensated Cirrhosis Diagnosed by Endoscopic Ultrasound-Guided Liver Biopsy (ACG 2026) - "The patient received liposomal amphotericin B followed by prolonged itraconazole therapy. This case highlights the importance of reconsidering the diagnosis when presumed cirrhosis is accompanied by unexplained liver injury and underscores the diagnostic utility of EUS-guided liver biopsy in patients with atypical liver disease. Figure: Computed tomography demonstrating ascites and imaging findings initially concerning for chronic liver disease and portal hypertension"

Biopsy • Autoimmune Hepatitis • Cardiovascular • Fibrosis • Hematological Disorders • Hepatology • Human Immunodeficiency Virus • Immunology • Infectious Disease • Inflammation • Inflammatory Arthritis • Liver Failure • Portal Hypertension • Rheumatoid Arthritis • Thrombocytopenia

A Case of Adalimumab-Associated Disseminated Histoplasmosis and Acute Liver Injury (ACG 2026) - "We describe a patient with rheumatoid arthritis, treated with adalimumab and methotrexate, who subsequently developed disseminated histoplasmosis (DH) complicated by acute hepatitis and Hemophagocytic Lymphohistiocytosis (HLH)...TNF-a therapy was discontinued, and she received two weeks of intravenous liposomal amphotericin B before transitioning to 12 months of oral itraconazole...Histoplasma capsulatum can remain dormant for years to decades, leading to reactivation even after remote exposure or in patients living outside classic endemic areas. This case highlights DH as a cause of acute hepatitis and underscores secondary HLH as a serious complication, where prompt identification of the trigger and timely therapy remain essential."

Clinical • Dyslipidemia • Gastroenterology • Hematological Disorders • Hemophagocytic lymphohistiocytosis • Hepatology • Hypertriglyceridemia • Immunology • Infectious Disease • Inflammatory Arthritis • Liver Failure • Metabolic Disorders • Pulmonary Embolism • Rare Diseases • Respiratory Diseases • Rheumatoid Arthritis • IL2

The Inflixi-Mask Comes Off: Colonic Ulcers Reveal Disseminated Histoplasmosis (ACG 2026) - "Case Description/ A 62 y.o male from Bakersfield, California with psoriatic arthritis (treated with infliximab and methotrexate) was referred to GI for evaluation of worsening abdominal pain for 6 months...He was diagnosed with disseminated histoplasmosis, and started on itraconazole with discontinuation of infliximab...This case highlights the importance of considering gastrointestinal histoplasmosis in immunosuppressed patients with unexplained colonic ulcerations, even outside traditionally recognized endemic regions. Figure: A. CT Abdomen/pelvis with fat stranding in distal transverse colon B. CT Chest with calcified right upper lobe granuloma and scattered pulmonary micronodules Figure: Colonoscopy revealing cratered ulcers in the transverse and descending colon"

Gastroenterology • Gastrointestinal Disorder • Immunology • Infectious Disease • Inflammatory Arthritis • Inflammatory Bowel Disease • Psoriatic Arthritis • Seronegative Spondyloarthropathies

Bridging the Gap: Safe Biologic Induction in Acute Severe Ulcerative Pancolitis Complicated by Concurrent Histoplasmosis (ACG 2026) - "Following ID clearance, IV methylprednisolone was initiated...Patient was discharged on prednisone 40 mg, itraconazole 300 mg BID, TMP-SMX prophylaxis, and outpatient infliximab, with complete resolution at two-month follow-up...Vedolizumab was considered given its gut-selective mechanism and attenuated systemic infectious risk, but infliximab was selected based on disease severity, established salvage efficacy in acute severe UC, and logistical constraints, with itraconazole and TMP-SMX prophylaxis...Biologic induction is not categorically contraindicated in histoplasmosis. Multidisciplinary ID clearance, antigen monitoring, and antifungal co-coverage can enable safe management."

Gastroenterology • Gastrointestinal Disorder • Immunology • Infectious Disease • Inflammation • Inflammatory Bowel Disease • Ulcerative Colitis

Necrotizing Nodes Causing Dysphagia: EUS-Guided Diagnosis of Mediastinal Histoplasmosis in a Teenager (ACG 2026) - "The patient was treated with itraconazole and experienced rapid improvement in dysphagia and appetite...Figure: 10x magnification of biopsied lymph node showing granuloma formation. Addition tissue samples showed necrotic material (not pictured here)."

Asthma • Gastrointestinal Disorder • Immunology • Respiratory Diseases

New-Onset Biliary Strictures in a Patient With IBD: Not Always PSC (ACG 2026) - "Ursodiol was started, and transplant evaluation was pursued...Itraconazole was started and infliximab was discontinued...Figure: a) H&E stain from ampulla demonstrating budding yeast. b) GMS stain from ampulla demonstrating budding yeast."

Clinical • Crohn's disease • Gastroenterology • Gastrointestinal Disorder • Hepatology • Immunology • Inflammatory Bowel Disease • Liver Failure • Primary Sclerosing Cholangitis

The Great Masquerader: Histoplasmosis Presenting as a Pancreaticobiliary (ACG 2026) - "The patient was started on itraconazole 200 mg twice daily...Recognition of infectious etiologies may prevent unnecessary surgical intervention and allows for appropriate antifungal therapy with subsequent radiographic improvement. Figure: Ulcerated Duodenal mass Figure: Cholangiogram during ERCP"

Biliary Cancer • Hepatology • Infectious Disease • Pancreatitis • Peptic Ulcer

Treatment of Isolated Nail Psoriasis with JAK Inhibitor Tofacitinib: A Case Report. (PubMed, Clin Cosmet Investig Dermatol) - "We present a 39-year-old female with a 6-year history of refractory isolated nail psoriasis, previously unresponsive to itraconazole, acitretin, topical antifungals, and corticosteroids. The present report offers preliminary evidence supporting the efficacy of a JAK inhibitor in the treatment of refractory isolated nail psoriasis. Large-scale controlled trials are warranted to confirm long-term safety and clinical efficacy."

Journal • Dermatology • Immunology • Infectious Disease • Inflammatory Arthritis • Psoriasis • Psoriatic Arthritis • Rheumatology • Seronegative Spondyloarthropathies • JAK1 • JAK3

Untargeted Metabolomics Reveal New Endogenous Plasma Biomarkers Associated with CYP3A Inhibition in Humans. (PubMed, Clin Pharmacol Ther) - "We characterized global metabolomic changes following itraconazole treatment in a fixed-sequence DDI study (11 healthy volunteers) to identify novel CYP3A endogenous biomarkers...Collectively, these findings expand the repertoire of sensitive and mechanistically supported endogenous biomarkers of CYP3A activity. Further evaluation of the newly identified GHCA and emerging bile acid metabolites across diverse CYP3A inhibitors can strengthen their translational utility in DDI risk assessment and drug development."

Biomarker • Journal • CYP3A4

Understanding the influence of stabiliser selection and concentration on the physical stability of dual-drug co-suspensions. (PubMed, Int J Pharm) - "In total, nine stabilisers were screened in combination with itraconazole and carbamazepine as individual suspensions and in co-suspensions, followed by evaluation of selected stabilisers using the cinnarizine-itraconazole system and concentration optimisation for the carbamazepine-itraconazole system. Increasing stabiliser concentration either enhanced or reduced milling efficiency depending on the formulation, and the concentration providing the greatest particle size reduction did not consistently provide the optimal physical stability. These findings demonstrate that although particle size characteristics of co-suspensions may follow the trends observed for one corresponding single-drug suspension, their physical stability cannot be predicted solely from the individual suspensions."

Journal • Infectious Disease