Drug-resistant fungus is raising international concern
In late 2022, a patient arrived at Bellevue Hospital in New York City with a perplexing case of scaly, itchy skin lesions. Despite being treated for what was believed to be ringworm, or tinea, with multiple rounds of topical steroids and antifungal medications, the condition persisted. The case came under the care of Dr. Avrom Caplan, a dermatologist and assistant professor at the NYU Grossman School of Medicine. Upon examining the patient, Dr. Caplan immediately recognized that this was no ordinary case of ringworm. Instead of just a few lesions, the patient’s thighs and buttocks were covered with numerous maddeningly itchy, striated disks, indicating an unusual and severe infection. As a dermatologist, Dr. Caplan’s first instinct was to consider whether the patient was immunosuppressed, a common concern when faced with such an extensive case of tinea. However, this patient did not have any underlying immunosuppression. Dr. Caplan prescribed four weeks of oral terbinafine, a widely used first-line antifungal drug. Surprisingly, the treatment had no effect. He then tried a month-long course of another oral antifungal, …
