Systemic lupus erythematosus-associated cutaneous cryptococcosis treated successfully with an intermittent 3-day on/off cycle of itraconazole

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We describe a case of systemic lupus erythematosus (SLE)-associated cutaneous cryptococcosis. A 32-year-old woman with SLE and lupus nephritis presented with the erythematous maculae on the chest and the extremities, in which encapsulated yeasts were revealed, and was diagnosed with secondary cutaneous cryptococcosis. We administered fluconazole (FLCZ) and then itraconazole (ITCZ) instead of amphotericin B (AMPH-B) to avoid the risk of renal toxicity of AMPH-B in the patient. While treatment with FLCZ was not particularly effective, repeated intermittent administration of ITCZ on a “3-day on/off cycle” (i.e. medication on 3 consecutive days and suspension for the next 3 days in turn) achieved complete remission of the cryptococcosis.

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