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This study evaluated combination therapy with miconazole and flucytosine for treating deep seated mycosis. Both mycological and clinical efficacy against candidemia and pulmonary cryptococcosis were satisfactory: All four isolated Candida spp. were eradicated and all four patients with candidemia were cured, while six of nine patients with pulmonary cryptococcosis exhibited clinical improvement. The efficacy of combination therapy appeared to be low against aspergillosis, since only one of two patients with invasive pulmonary aspergillosis and two of five patients with pulmonary aspergilloma exhibited clinical improvement. Nevertheless, the clinical efficacy against aspergillosis was higher than that obtained with monotherapy in our previous study. Adverse reactions were observed in 36% (13 of 36) and abnormal laboratory findings in 22% (8 of 36) of patients treated with combination therapy; these rates were higher than those reported for monotherapy. These increases were not due to changes in serum concentrations of the two drugs due to simultaneous administration. The findings of this study suggest that combination therapy with miconazole and flucytosine may be an alternative therapy for refractory mycoses for carefully chosen patients. [ABSTRACT FROM AUTHOR]

Here, we report a 56-year-old patient with rheumatoid arthritis (RA) who had been treated with methotrexate and sulfuasalazine, but the disease activity remained high. Therefore, we planned TNF-blocker treatment for this patient. A tuberculin skin test was positive, we started anti-tuberculosis (TB) chemoprophylaxis with isoniazid (INH). However, liver dysfunction was appeared after 2 weeks from the start of INH. Therefore, we discontinued INH transiently and tried the desensitization of INH. However, interstitial pneumonia was developed 2 weeks after the re-start of INH, we decided to stop the INH prophylaxis. Interstitial pneumonia was improved by corticosteroid treatments. This case report shows that INH-induced IP can be occurred during the course of anti-TB chemoprophylaxis in patients with RA. [ABSTRACT FROM AUTHOR]