298 A n t i b i o t i c E s s e n t i a l s

Myositis

Subset	Pathogens	Preferred Therapy
Chromomycosis	Cladosporium/Fonsecaea	Itraconazole 200 mg (PO) q24h until cured
		or
		Terbinafine 250 mg (PO) q24h until cured
Trichinosis	Trichinella spiralis	Albendazole 400 mg (PO) q12h × 8–14 days
		or
		Mebendazole 200–400 mg (PO) q8h × 3 days, then
		400–500 mg q8h × 10 days

Chromomycosis (Cladosporium/Fonsecaea)

Clinical Presentation:  Subcutaneous/soft tissue nodules or verrucous lesions..

Diagnostic Considerations:  Diagnosis by demonstrating organism by culture/tissue biopsy specimen­. Pitfalls:  May resemble Madura foot or cause ulcerative lesions in muscle..

Prognosis:  Related to degree of immunosuppression..

Trichinosis (Trichinella spiralis)

Clinical Presentation:  Muscle tenderness, low-grade fevers, peripheral eosinophilia, conjunctival suffusion..

Diagnostic Considerations:  Diagnosis by Trichinella serology or by demonstrating larvae in muscle biopsy..

Pitfalls:  ESR is very low (near zero), unlike other causes of myositis, which have elevated ESRs.. Prognosis:  Excellent with early treatment.. Short-term steroids may be useful during acute phase.. Therapy is ineffective against calcified larvae in muscle..

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