RT Book, Section A1 Sheppard, Don A1 Lampiris, Harry W. A2 Katzung, Bertram G. A2 Trevor, Anthony J. SR Print(0) ID 1104848888 T1 Antifungal Agents T2 Basic & Clinical Pharmacology, 13e YR 2015 FD 2015 PB McGraw-Hill Medical PP New York, NY SN 9780071825054 LK accessmedicine.mhmedical.com/content.aspx?aid=1104848888 RD 2021/03/07 AB CASE STUDYA 55-year-old man presents to the emergency department with a 2-week history of an expanding ulcer on his left lower leg. He has a history of chronic neutropenia and transfusion-dependent anemia secondary to myelodysplastic syndrome requiring chronic therapy with deferoxamine for hepatic iron overload. He first noticed a red bump on his leg while fishing at his cabin in the woods and thought it was a bug bite. It rapidly enlarged, first as a red swollen area, and then began to ulcerate. He was given dicloxacillin orally, but with no improvement. In the emergency department he is febrile to 39°C (102.2°F), and looks unwell. On his left leg he has a 6 by 12 cm black ulcer with surrounding swelling and erythema that is quite tender. His complete blood count demonstrates an absolute neutrophil count of 300 and a total white blood cell count of 1000. An immediate operative debridement yields pathologic specimens demonstrating broad club-like nonseptate hyphae and extensive tissue necrosis. What initial medical therapy would be most appropriate?