Message Number: SG15378 | New FHL Archives Search
Date: 2005-09-17 00:02:11 UTC
Subject: mycetomas (fungus lump) beneath the jaw
Message-ID: <>

5 yo Cokey Puff has aquired a growing lump in her neck beneath her jaw, It =
was the size of 3 quarters 3 months ago. Vet biopsy said it was cryptococcu=
s neoformans. Lets try her on itraconazole 50 mg per day (human cases want =
400 mg qd so this is a generous dose.) We dont want to go to amphoteracin B=
("amphoterrible" - really toxic). Now after one month it is the size of 4 =
silver dollars. growing. No point in surgically debulking it if it is desti=
ned to have the remnants keep right on growing. Its not sore or painful. Bu=
t there nonetheless - growing. No systemic illness. (I as a human doc am us=
ed to seeing Coccidio in aids patients where it immediately becomes systemi=
c and ravages the person in 5 days to death.) Could the pathologists DX be=
wrong. Lumpy jaw in cattle is actinomycosis, (or nocardiomycosis with sulf=
ur crystals) and that is exquisitely sensitive to penicillen, no resistance=
whatsoever. Hi PCN doses (20 mil units qd in humans)for 4 months just melt=
this one away no problemo.(I had one of the less than 10 cases of lumpy ja=
w in a human on record, a disbarred lawyer who slept under church stairs on=
the ground and in dumpsters for 4 years.) (I'm always astonished that peni=
cillen should have any effect on any fungal disease. Who knew?) Should I as=
k for a new culture and call the pathologists who read the slide to see if =
there is any difficulty distinguishing coccidio from actino on a slide. 'Pr=
eciate any thoughts on this. Tom


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