Case Of Primary Cutaneous Aspergillosis Research Articles

Primary cutaneous aspergillosis in an immunocompetent individual

<p class="abstract">Aspergillosis is an uncommon fungal infection in which primary cutaneous sites are very rare. Most cases occur in immunocompromised patients and infection in immunocompetent patients, is extremely rare, but an increase in prevalence has been noted in last 20 years. A case of primary cutaneous aspergillosis (PCA) in a 40-year-old immunocompetent shopkeeper resident of Jaipur Rajasthan presenting with verrucous growth on the lower lip has been reported in this case study.</p>

A Rare Case of Primary Cutaneous Aspergillosis of the Scalp in an Immunocompetent Patient

Aspergillosis is a rare invasive fungal infection caused by numerous species of aspergillus. Few species of Aspergillus are pathogenic in human existence. The most frequent are aspergillus fumigatus and flavus [1]. Cutaneous aspergillosis remain an uncommon form, it may be primary, affecting the site of skin trauma or secondary due to hematogenous spread from a contiguous anatomic location [2]. Here we describe a rare case of primary cutaneous aspergillosis located on the scalp in an immunocompetent host, which continue to be undiagnosed for a long period of time by dermatologists.

超低出生体重児に生じた原発性皮膚アスペルギルス症の1例

超低出生体重児に生じた原発性皮膚アスペルギルス症の1例

Primary Cutaneous Aspergillosis in a Patient with CARD9 Deficiency and Aspergillus Susceptibility of Card9 Knockout Mice.

We describe a case of primary cutaneous aspergillosis caused by Aspergillus fumigatus, and elucidate the underlying genetic and immunological mechanisms. Routine clinical and laboratory investigations were performed. Whole-exome sequencing of the patient's DNA suggested the presence of a CARD9 mutation, which was confirmed by Sanger sequencing. Innate and adaptive immunological responses of patient-derived CARD9-deficient cells were evaluated with ELISA and flow cytometry. Cutaneous and pulmonary aspergillosis models were established in Card9 knockout (KO) mice, which were compared with wild-type and immunosuppressed mice, to explore the pathogenesis and Aspergillus susceptibility. A 45-year-old man presented with a 37-year history of skin lesions on his face. A diagnosis of primary cutaneous aspergillosis was made through histopathology, immunohistochemistry, and tissue culture. Sanger sequencing of CARD9 showed a homozygous frame-shift mutation (c.819_820insG, p.D274fsX60), which led to the lack of CARD9 expression. Peripheral blood mononuclear cells from the patient showed selective impairment of proinflammatory cytokines, and Th1-, Th17-, and Th22-associated responses upon fungus-specific stimulation. The cutaneous aspergillosis model established in Card9 KO mice presented with persistent infection, with fungal germs and short hyphae in tissue, consistent with the patient's lesions. Skin lesions in immunosuppressed mice were more severe, and led to death. Unlike our patient, Card9 KO mice were relatively susceptible to pulmonary aspergillosis, with reasons to be investigated. This is, to our knowledge, the first report that links cutaneous aspergillosis to CARD9 mutation. This work enriches both the phenotypic spectrum of CARD9 deficiencies and the genetic background of cutaneous aspergillosis.

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

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

A Case of Primary Cutaneous Scar Infection Caused by Aspergillus niger.

Dear Editor: Here, we report the case of a 78-year-old healthy woman who presented with a 7.5×8-cm erythematous eschar-like crusted indurated plaque and pustules with purulent discharges on a chicken-pecked scar on the right forearm that developed 2 month prior to her visit (Fig. 1). The patient was diagnosed with type 2 diabetes and hypertension 12 years earlier. She was afebrile and otherwise healthy. Fig. 1 Erythematous eschar-like crusted indurated plaque and pustules with purulent discharges on the right forearm. Skin biopsy was performed, including staining with hematoxylin and eosin, and Gomori methenamine silver (GMS) for histologic, bacteriologic, and mycologic examination. The histologic sections stained with hematoxylin and eosin exhibited numerous dichotomously branching and septate hyphae in the granulated tissue. Meanwhile, GMS staining showed dark brown/black-colored hyphae walls (Fig. 2). Cultures from the skin biopsy specimens and exudates on Sabouraud's agar at 37℃ repeatedly exhibited rapidly growing colonies consistent with Aspergillus niger. On the basis of these findings, the patient was diagnosed with primary cutaneous aspergillosis due to A. niger. The patient was treated with oral terbinafine hydrochloride 250 mg/day for 3 months, which resulted in complete healing of the lesion 12 weeks after treatment initiation. Fig. 2 Septate hyphae with dichotomous branching in the dermis (Gomori methenamine silver, ×400). Cutaneous aspergillosis can occur as either a primary or secondary infection1,2. The initial infection is clinically characterized by macules, papules, nodules, plaques, or hemorrhagic bullae, which may progress into necrotic ulcers covered by a heavy black eschar3. The diagnosis of most cutaneous aspergillosis infections generally requires the biopsy of a skin lesion for both culture and histopathology. Fungal isolates from culture media are identified on the basis of colony morphology, color, and sporulation. Meanwhile, histopathologic examination with routine stains variably demonstrates Aspergillus hyphae. GMS stain clearly shows hyphae, because the hyphal cell walls stained black, whereas the tissue background stained green (Fig. 2). Aspergillus hyphae should have acute-angle branching and frequent septations. The fruiting bodies of Aspergillus are rarely observed in tissue samples unless there is an overwhelming burden of organisms at the site. Therefore, although a tentative diagnosis of aspergillosis can be made on the basis of histopathologic GMS staining, a definitive diagnosis requires the identification of Aspergillus grown in culture. The recommended treatment for primary cutaneous aspergillosis includes voriconazole, itraconazole, and amphotericin B. However, recent studies suggest a significant portion of Aspergillus species may be resistant to conventional treatment4. In the present case, oral administration of terbinafine 250 mg/day was effective. Primary cutaneous aspergillosis caused by A. niger in a healthy patient is extremely rare. To our knowledge, only few cases have been reported worldwide, including only 1 case in Korea5. In summary, we present a unique and interesting case of primary cutaneous aspergillosis caused by A. niger.

Primary cutaneous aspergillosis with lung involvement in a transplant patient

Invasive pulmonary aspergillosis (IPA) is a rare, life-threatening infection in liver transplant recipients. Here, we report a case of primary cutaneous aspergillosis with following lung involvement in a liver transplant recipient. The survival rate of patients with IPA can be increased by early diagnosis using high-resolution computed tomography, a combination of two effective antifungal agents, temporal reduction or cessation of immunosuppressive drugs, and surgical intervention with video-assisted thoracoscopic surgery.

Soft Tissue Abscess Caused by Aspergillus Fumigatus in an Immunosuppressive Patient

Aspergillosis is a definition including a wide variety of diseases caused by fungi in the genus Aspergillus. Aspergillosis that occurs especially in neutropenic and immunosuppressive patient is an opportunistic infection with a very high mortality rate. In this study, we presented a case of primary cutaneous aspergillosis that caused in a heart transplant recipient. Thirty-nine-years-old male patient with the complaints of high fever lasting for ten days, redness of the right thigh, swelling, and pain, was admitted to our hospital. By the tissue ultrasonography of right thigh, 3x12 cm in size of septated intensive fluid collection (abscess?) in muscle tissue at a depth of 1.5 cm to the skin surface was reported. The biopsy specimens that were taken from the lesion sent to microbiology and pathology laboratories. The branching septate hyphae were observed in Hematoxylin-Eosin and Gram stained preparations. Aspergillus fumigatus was isolated and identified from the biopsy specimen. The patient’s symptoms were regressed rapidly and the lesion was improved by surgical debridement and antifungal agent (amphotericin B) therapy. In the light of this case report, we were emphasized that microbiologic examination and culture have an important role for diagnosis of cutaneous aspergillosis.

Cutaneous aspergillosis associated with HIV infection

Primary cutaneous aspergillosis is rare but has been described in immunosuppressed individuals. Cutaneous aspergillosis associated with HIV infection, to date, has primarily been described in hospitalized individuals with advanced HIV following skin trauma. We describe a case of primary cutaneous aspergillosis in a HIV-infected, antiretroviral therapy naïve patient with moderate immunosuppression.

Primary cutaneous aspergillosis from Tamilnadu diagnosed by fine needle aspiration cytology

Aspergillus are ubiquitous and more than 30 species have been reported to be involved in human infection. Most of the cases occur in immunocompromised patients and are disseminated in the blood. Primary cutaneous aspergillosis in immunocompetent hosts is rare. We report a unique case of primary cutaneous aspergillosis in an immunocompetent patient diagnosed by fine needle aspiration cytology. The characteristic ascocarp and ascospores of Aspergillus species were found in the aspirate and Aspergillus glaucus was isolated in pure culture. The case is presented to increase the awareness of the usefulness of fine needle aspiration cytology for diagnosing fungal infections.

Primary cutaneous aspergillosis due to Aspergillus flavus in a neutropenic patient

Summary Cutaneous aspergillosis is a rare disease that generally affects immunosuppressed patients. We report a case of primary cutaneous aspergillosis developed at the site of cervical lymphadenectomy in a 32-year-old man with underlying anaplastic large T-cell lymphoma. The lymphadenectomy was performed to confirm relapse of the malignancy. Wound infection developed during the second week of post-chemotherapy neutropenia. Histopathologic examination of a skin biopsy specimen showed abundant hyphae, cultures yielded Aspergillus flavus and galactomannan antigenemia was positive. Treatment consisted of combination of voriconazole and surgical debridement. Patient died of multiorgan failure caused by bacterial sepsis without secondary dissemination of the Aspergillus infection. Conclusion Aspergillus infection should always be considered in the differential diagnosis of wound infections, especially in neutropenic patients.

Severe cutaneous aspergillosis in a premature neonate linked to nonsterile disposable glove contamination?

After having eliminated a dysfunction of the hospital's ventilation system and any other possible environmental reservoir, the investigation of a fatal case of primary cutaneous aspergillosis in a neonate with extremely low birth weight led to the conclusion that nonsterile disposable gloves kept stored in their native packages were the likely source of contamination.

A Case of Primary Cutaneous Aspergillosis

A Case of Primary Cutaneous Aspergillosis

Aspergillose cutanée secondairement invasive chez un nouveau-né prématurissime : cas clinique et revue de la littérature

Aspergillus is a ubiquitous fungus that can cause primary cutaneous aspergillosis in extremely low-birth-weight (ELBW) neonates, then be invasive and lead to death. ELBW neonates are particularly at risk because of decreased qualitative immune defenses and defects in the skin barrier. Broad-spectrum antimicrobial therapy and corticosteroids, often used in these patients, contribute to increased risk. We present a fatal case of primary cutaneous aspergillosis complicated with invasive aspergillosis, confirmed by autopsy, in an ELBW infant. The source of contamination was probably non-sterile disposable latex gloves used for neonatal care. The early recognition of this source led to its eviction for other hospitalized ELBW infants and no outbreak was observed.

Aspergillose cutanée primitive chez un agriculteur immunocompétent

Aspergillosis is an uncommon fungal infection in which primary cutaneous sites are very rare. Most cases occur in immunodepressed patients and are disseminated in the blood. We report a case of primary cutaneous aspergillosis in a 37-year-old immunocompetent farmworker presenting as a kerion-like lesion. A 37-year-old farmworker presented erythematous and nodular lesions of the face. These lesions were not associated with any general symptoms and failed to respond to antibiotic treatment. Histological examination of a skin biopsy sample showed a granulomatous reaction in the dermis associated with an extensive neutrophilic infiltrate. PAS staining revealed the presence of right-angled branched hyphae with conidia. Aspergillus fumigatus was isolated and identified in cultures. Clinical and biological examinations did not reveal any systemic localisation of aspergillosis, ruling out the hypothesis of blood dissemination. This primary cutaneous infection occurred in an immunocompetent patient, in whom laboratory tests ruled out any underlying immunosuppression. Systemic antifungal treatment with voriconazole led to complete resolution. Reports in the literature of primary cutaneous aspergillosis in immunocompetent patients are extremely rare. Clinical lesions may comprise often painful weeping or necrotic macules or papules or subcutaneous nodules that can progress towards abscess or necrosis. The semiological similarity between these lesions and kerions can lead to misdiagnosed cases and delayed treatment.

Primary Cutaneous Aspergillosis

© 2010 The Authors. doi: 10.2340/00015555-0865 Journal Compilation © 2010 Acta Dermato-Venereologica. ISSN 0001-5555 Cutaneous aspergillosis has been described as primary or secondary to haematogenous dissemination (1). Primary cutaneous aspergillosis usually follows local trauma and appears as a purplish oedematous lesion at the site of inoculation (2). We present here a rare case of primary cutaneous aspergillosis, which manifested as intractable nodules.

Primary cutaneous aspergillosis in a patient with cutaneous T‐cell lymphoma

We present a case of primary cutaneous aspergillosis caused by Aspergillus terreus in a patient with cutaneous T-cell lymphoma. A 41-year-old woman bruised her left shin and presented with a 1 x 2 cm ecchymosis on the upper third of the left shin for over 6 months. Before mycological examination and sequential biopsies, the patient was erroneously treated with antibiotics and local debridement. After final diagnosis of cutaneous aspergillosis caused by A. terreus cutaneous T-cell lymphoma on the basis of mycological, histopathological and immunohistochemical findings, the patient responded well to oral itraconazole and chemotherapy for over 1 month.

Primary Cutaneous Aspergillosis in an Immunocompetent Patient: Successful Treatment with Oral Voriconazole

We report a case of primary cutaneous aspergillosis in an immunocompetent child that responded rapidly to oral voriconazole therapy. Voriconazole may be considered as a treatment option for pediatric patients with primary cutaneous aspergillosis.

A case of primary cutaneous aspergillosis in a renal transplant recipient

Opportunistic fungal infections are life-threatening complications which are a major cause of morbidity and mortality in immunocompromized hosts such as those who have undergone organ transplantation. Aspergillosis comprises a spectrum of disease caused by a ubiquitous saprophytic mold. Invasive aspergillus is a serious life-threatening complication in immunocompromised hosts. Primary cutaneous aspergillosis occurs relatively less frequently and is poorly characterized. We report a case of cutaneous aspergillosis in a 51-year-old renal transplant recipient, which was successfully treated with local excision and concomitant antifungal therapy. Case A 51-year-old male renal transplant recipient presented with cutaneous nodules on the dorsum of the right hand. He underwent renal transplantation for end-stage renal disease due to adult dominant polycystic kidney disease (ADPKD) 3 years prior. Initially he suffered an acute rejection episode that was treated with steroid pulse and OKT3 therapy. Eventually he was stabilized on a combination of tacrolimus, prednisone, and mycophenolate mofetil. Three years after transplanation, he developed painless multiple (largest one 5 × 3 cm sized) nodules on the dorsum of his right hand. He was afebrile with no systemic symptoms. A skin biopsy showed a dense solid infiltration of giant cells, histiocytes, and lymphoplasma cells admixed with intra- and extracelluar fungal hyphae and spores. The hyphae were septate and acute angle branching, which was consistent with aspergillosis. Oral itraconazole 200 mg/d for 5 weeks was ineffective. Treatment with liposomal amphotericin B for 4 weeks was initated and MMF was discontinued. The medication was well tolerated with no hepatotoxic effects. Although new lesions did not appear, existing ones did not significantly improve after 4 weeks of treatment. Therefore, most lesions were excised surgically and liposomal amphotericin B continued for 2 weeks followed by treatment with oral fluconazole for 2 months. Ten moths later there was no evidence of recurrence.

Fatal primary cutaneous aspergillosis in a bone marrow transplant recipient: nosocomial acquisition in a laminar-air flow room

A case of primary cutaneous aspergillosis occurring in an allogeneic bone marrow transplant recipient in a laminar airflow room is reported. The patient developed grade III graft-versus-host-disease and epidermolysis. Although the patient had remained in his laminar airflow room from the graft onward, he subsequently developed primary cutaneous aspergillosis. The aspergillosis became invasive and the patient died. The patient was probably contaminated by air containing conidia when he left the sterile room for endoscopy, and the fluidized bed used may have contributed to the local development of the disease. This nosocomial aspergillosis stresses the necessity of performing invasive procedures under laminar airflow protection to prevent Aspergillus contamination in immunocompromised hosts at risk for aspergillosis.