Aspergilosis diseminada con importante afectación cutánea / Disseminated aspergillosis with significant skin involvement

La Aspergilosis es una infección micótica oportunista que afecta principalmente a pacientes inmunodeprimidos con neutropenia, en quienes produce a menudo enfermedad invasiva de curso fulminante. Las manifestaciones cutáneas de la Aspergilosis son infrecuentes, apareciendo en el 5 a 10% de los casos diseminados. Comunicamos un caso de Aspergilosis en una mujer adulta con neutropenia severa por enfermedad hematológica, con afectación pulmonar y sinusal, que presenta múltiples lesiones ulceronecróticas en piel y mucosas, con evolución fatal. Las lesiones mucocutáneas de la Aspergilosis no son específicas, obligan a varios diagnósticos diferenciales y, como en este caso, la biopsia para estudio histopatológico y micológico es necesaria para el diagnóstico.

Aspergillosis is an opportunistic fungal infection that primarily affects immunocompromised patients with neutropenia, in whom invasive disease often results in fulminant course. Cutaneous manifestations of aspergillosis are rare, occurring in 5-10% of cases scattered. We report a case of aspergillosis in an adult woman with severe neutropenia for hematologic disease, lung and sinus disease, having multiple ulceronecróticas skin lesions and mucous membranes, with fatal outcome. The mucocutaneous lesions of aspergillosis are nonspecific, forcing several differential diagnoses, and as in this case, the biopsy for histopathological and mycological study is required for diagnosis.

A Case of Primary Cutaneous Aspergillosis of the Dorsum of Hand Due to Aspergillus niger Manifested by Edematous Lesion / 대한의진균학회지

Aspergillus is the most ubiquitous fungi found in soil, water and decaying vegetation. It commonly affects immunocompromised individuals and in primary cutaneous aspergillosis, the skin is directly inoculated of spores by intravenous catheters, trauma and surgery. Primary cutaneous aspergillosis is a rare entity, mostly caused by Aspergillus(A) flavus, A. fumigatus, and rarely, by A. niger. And clinically, the lesion is usually characterized by macules, papules, nodules or plaques. In our case, a 71-year-old male visited with erythmeatous swollen patch and two ulcers on the dorsum of left hand. There was no other associated medical illness except diabetes mellitus and gastric ulcer, and no history of trauma or invasive procedure. The skin biopsy and the culture of cutaneous lesions confirmed the diagnosis of primary cutaneous aspergillosis by A. niger. Herein, we report a rare case of primary cutaneous aspergillosis due to A. niger manifestated by edematous lesion.

A case of dual infection in a paediatric trauma victim of primary cutaneous aspergillosis caused by Aspergillus flavus and Aspergillus terreus.

Aspergillus spp. are widely distributed throughout the environment. They are opportunistic pathogens causing infection at various sites in the body such as lungs, sinuses, eyes, skin, central nervous system etc., Primary cutaneous aspergillosis is an uncommon disease entity. Primary infections usually occur at sites having disruption of the skin and usually occur in burn patients, trauma and surgical patients. A 4-year-old girl who was run over by a truck and suffered extensive de-gloving injury to bilateral lower limbs developed greenish discharge and scaly lesions around the wound margins after 50 days of hospital stay. The skin biopsy demonstrated the presence of thin septate hyphae branching at acute angles and culture demonstrated growth of Aspergillus flavus and Aspergillus terreus. The child was started on voriconazole therapy for 3 weeks and the lesion healed satisfactorily. Subsequent skin biopsy culture was negative for fungi. Prompt diagnosis and management of such cases can salvage the limbs in severe trauma cases.

A Case of Disseminated Aspergillosis Presenting Solely as Multiple Cutaneous Lesions in an Acute Leukemia Patient / 감염과화학요법

Invasive aspergillosis (IA) is a major cause of morbidity and mortality in patients with hematological malignancies. While the development of new effective antifungals and advancement of diagnostic techniques have lead to improved outcomes, relapse of IA in patients with subsequent immunosuppression is emerging as a major issue. The primary IA site is the most common relapse site, but disseminated infection from the lung to multiple organs, including the brain, thyroid, liver, spleen, kidney, bone, heart valve, and skin, can often occur in patients with severe immunosuppression. Furthermore, relapsing or disseminated IA have very poor outcomes. We report a case of disseminated IA presenting as multiple cutaneous lesions without involvement of any other organs in an acute leukemia patient. The patient had suffered from prior invasive pulmonary aspergillosis, which was treated successfully. The multiple skin lesions were fully resolved after antifungal therapy for 6 weeks.

Primary cutaneous aspergillosis due to Aspergillus niger in an immunocompetent patient.

Primary cutaneous aspergillosis is a rare entity, usually caused by A. fumigatus and A. flavus . Here, we present such a case, manifested by ulceration due to A. niger, which remained undiagnosed for a prolonged period. The immunological status was intact, although the patient had associated severe fungal infection. Recurrence of the lesion occurred despite repeated anti-fungal therapies. Anti fungal testing was done based on the broth dilution (M-38A, NCCLS, USA) method. The culture isolate was found to be sensitive to fluconazole and amphotericin B. Continuation of antifungal therapy improved the symptoms, reducing the size of the lesion.

A Case of Primary Cutaneous Aspergillosis / 대한피부과학회지

The genus Aspergillus is widely distributed in nature, and causes lung, central nervous system, and nose-orbital region infection, plus immune deficiency. Primary cutaneous aspergillosis occurs prevalently in immunocompromized patients. Only seven cases of primary cutaneous aspergillosis which occurred in immunocompetent patients has been reported in the world. We report a case of primary cutaneous aspergillosis which occurred in an 84 year old female patient who had a normal immune status.

A Case of Primary Cutaneous Aspergillosis on the Scalp and the Neck

The cutaneous aspergillosis is one of the most common dermatologic manifestations of disseminated infections associated with the Aspergillus organisms, but the isolated primary cutaneous disease itself can rarely occur in an immunocompetent host. We report a case of the primary cutaneous aspergillosis on the scalp and the neck in a 39-year-old immunocompetent male patient. There was a single purulent ulcer surrounded by the erythematous indurated plaque on the scalp with multiple satellite papules and a multi- lobulated granulomatous plaque with a crust on the neck. Skin biopsy demonstrated a fungus, the Aspergillus, in the deep dermis as the etiologic agent. No evidence of involvement in other organs was found. The patient exhibited no other apparent systemic diseases nor immunologic defects. An elliptical excision and a primary closure was performed, and the adjuvant antifungal treatment, oral itraconazole, was applied to prevent the recurrence by the satellite lesions.

Primary Cutaneous Aspergillosis Complicating the Grafted Skin after Burn / 대한피부과학회지

A 60-year-old healthy man was consulted with dark brown eschars and purulent discharges on the grafted skin of a burn scar on the posterior aspect of both lower extremities which had developed two weeks after the skin graft. Aspergillus fumigatus was isolated by repeated fungal cultures from pus and tissue pieces. Also septate hyphae branching at an acute angle are seen in the dermis in PAS-stained section. After two weeks therapy with fluconazole and itraconazole, the patient accepted skin graft again. The skin lesion was improved after prophylactic itraconazole treatment for three weeks.

A Case of Primary Cutaneous Infection of the Burn Scar by Aspergillus niger / 대한의진균학회지

A 61-year-old healthy breeder presented with three punched out, purulent ulcers surrounded by erythematous indurated plaque on the burn scars of the dorsum of the right upper arm and hand which were developed at six months prior to visit. Aspergillus niger was isolated from the pus and tissue pieces in three consecutive cultures. After eight weeks therapy with oral itraconazole, purulent ulcers were healed leaving fibrotic scars. We report a rare case of primary cutaneous aspergillosis by A. niger in a healthy man.

Cutaneous Aspergillosis / 대한의진균학회지

Aspergillosis comprises a spectrum of diseases caused by species of a ubiquitous saprophytic mold, Aspergillus, that usually lives on decaying vegetation. Aspergillus organisms rarely behave as pathogens in an immunocompetent host. But, in the presence of immunosuppression, Aspergillus may be invasive and take a fulminant course. Although extensive investigation has clarified multiple aspects of pulmonary aspergillosis, cutaneous aspergillosis occurs relatively less frequently and therefore remains poorly characterized. With this review, we have attempted to better define risk factors and common clinical presentations, as well as to formulate a reasonable approach to the diagnosis and management of cutaneous aspergillosis.

A Case of Primary Cutaneous Aspergillosis in Acute Lymphocytic Leukemic Child / 대한피부과학회지

A 7-year-old boy with acute lymphocytic leukemia was presented with a few painful erythematous deep seated nodules on the abdomen, leg, and arm. In the skin biopsy, fungal hyphae were found in the deep dermis and subcutaneous tissue. Aspergillus flavus was cultured and isolated by repeated fungal culture from tissue pieces of skin biopsy specimens. A chest X-ray, chest CT and ultrasonography of the upper abdomen revealed no abnormalities, so he was diagnosed by primary cutaneous aspergillosis. We started treatment with amphotericin B and surgical resection, but he had already developed sepsis and expired.

Disseminated aspergillosis with cutaneous aspergillosis and aspergergillus thyroiditis in a renal allograft recipient / 대한내과학회지

Though advances in immunosuppressive therapy have led to increased survival of renal transplant patients, but increased risk of developing infectious complications. Aspergillosis is a second common opportunistic fungal infection in a renal transplant patient. Lungs, brain and sinuses are the main targets of this fungal infection, but involvement of thyroid gland is rare. We report a case of disseminated aspergillosis with cutaneous aspergillosis and Aspergillus thyroiditis with thyrotoxicosis in a renal allograft patient.

A Case of Primary Cutaneous Aspergillosis in Acute Lymphocytic Leukemin Child / 대한피부과학회지

No abstract available.

Primary Cutaneous Aspergillosis from the Burn Wound of a Diabetic Patient / 대한피부과학회지

A 68 year-old man with uncontrolled diabetes mellitus was presented with a single 4 * 2.5cm sized undermined purulent ulcer with a black eschar surrounded by erythematous indurated plaques on the dorsurn of the his left foot. Fungal hyphae were found in the deep dermis of the skin biopsy specimen. Aspergillus flavus was cultured and isolated by repeated fungal cultures from the pus and tissue pieees of skin biopsy specimens. Wide surgical debridement followed by a skin graft, and adjuvant antifungal treatment applied twice did not cure the skin lesion. We report a case of cutaneous aspergillosis showing a poor outcome in spite of surgical therapy and antifungal medication.

A Case of Primary Cutaneous Aspergillosis / 대한의진균학회지

We report a case of primary cutaneous infection by Aspergillus fumigatus in a 19-year-old immunocompetent woman. She developed pruritic erythematous papules on the frontal and temporal scalp area and pubic area. The lesions rapidly progressed to ulcers with central black eschars and pus drainage. The diagnosis of Aspergillus fumigatus infection was established by the mycologic study of cultures from wound exudate and histopatholosic examination of the skin lesion. The skin lesions were improved after 5 weeks of antifungal therapy with oral itraconazole (200mg/day). Five months later, the skin lesions had healed, leaving some scar.

Primary Cutaneous Aspergillosis in a Patient with Breast Carcinoma / 대한피부과학회지

Following chemotherapy and radiation treatment for infiltrating ductal carcinoma of the left breast, a 50-year-old woman presented with a child's palm sized, crusted patch and surrounding peanut sized granulated nodules on the lesion, which was diagnosed as primary cutaneous aspergillosis caused by Aspergillus fumigatus. No evidence of involvement of other organs or of systemic dissemination by Aspergillus femigatus was found. Also the patient exhibited no other apparent systemic immunologic defects. Extensive excision were performed and the patient received treatment with amphoteriein B. No evidence of recurrent fungal infection was noted during 6 months of follow-up.