RESUMEN
BACKGROUND: Antibiotics have been shown to improve hidradenitis suppurativa (HS) patients but complete remission is rare using these treatments. OBJECTIVE: To assess the efficacy and safety of a combination of oral rifampin, moxifloxacin and metronidazole in long-lasting refractory HS. METHODS: We retrospectively studied 28 consecutive HS patients including 6, 10 and 12 Hurley stage 1, 2 and 3 patients, respectively. Complete remission, defined as a clearance of all inflammatory lesions including hypertrophic scars, was the main outcome criterion of the study. RESULTS: Complete remission was obtained in 16 patients, including 6/6, 8/10 and 2/12 patients with Hurley stage 1, 2 and 3, respectively (p=0.0004). The median duration of treatment to obtain complete remission was 2.4 (range 0.9-6.5) and 3.8 months (range 1.6-7.4) in stage 1 and 2 patients, respectively, and 6.2 and 12 months in the 2 stage 3 patients. Main adverse events of the treatments were gastrointestinal disorders (64% of patients) and vaginal candidiasis (35% of females). Reversible tendinopathy and hepatitis occurred in 4 and 1 patient, respectively. CONCLUSIONS: Complete remission of refractory HS can be obtained using broad-spectrum antibiotics and Hurley staging is a prognostic factor of response to the treatment.
Asunto(s)
Antiinfecciosos/uso terapéutico , Antibióticos Antituberculosos/uso terapéutico , Compuestos Aza/uso terapéutico , Hidradenitis Supurativa/tratamiento farmacológico , Metronidazol/uso terapéutico , Quinolinas/uso terapéutico , Rifampin/uso terapéutico , Adulto , Antiinfecciosos/efectos adversos , Antibióticos Antituberculosos/efectos adversos , Compuestos Aza/efectos adversos , Quimioterapia Combinada , Femenino , Fluoroquinolonas , Hidradenitis Supurativa/patología , Humanos , Estimación de Kaplan-Meier , Modelos Logísticos , Masculino , Metronidazol/efectos adversos , Persona de Mediana Edad , Moxifloxacino , Pronóstico , Quinolinas/efectos adversos , Recurrencia , Inducción de Remisión , Estudios Retrospectivos , Rifampin/efectos adversos , Resultado del Tratamiento , Adulto JovenRESUMEN
Nocardia veterana is a recently characterized species within the genus Nocardia, and only three human clinical isolates have been reported for this species. We describe a case of ascitic fluid infection in an immunocompromised patient due to N. veterana. To our knowledge, this is the first report of a Nocardia sp. strain from ascitic fluid and the fourth report of N. veterana isolated from human samples. Chemotaxonomic methods showed the strain to belong to the genus Nocardia, and identification to the species level was done by 16S ribosomal DNA gene sequencing. The antibiotic susceptibility profile of N. veterana is reported here for the second time. The strain was deposited in the Collection of the Pasteur Institute and in the Culture Collection of the University of Göteborg (CIP 107497 and CCUG 46576). The corresponding 16S ribosomal DNA gene sequence is available from the GenBank database under accession number AY149599. A phylogenetic analysis was conducted and showed that N. veterana was most closely related to the recently characterized species Nocardia africana rather than to Nocardia vaccinii, as previously reported.