Primary cutaneous aspergillosis in an immunocompetent patient

Abstract

We present a 32-year-old woman with primary cutaneous aspergillosis and an apparently normal immune status. She is a dietitian who carried out research on Aspergillus contamination of palm oil over a six-month period, during which she apparently shaved her axillae and perineum using a safety razor blade. She presented with nodular lesions, which became extensive ulcers after an attempt at incision and drainage. Diagnosis was based on culture and histology. The patient was treated with itraconazole 200 mg twice a day, with surgical excision and a rhomboid flap cover of the axillae. She has remained disease-free five years after discharge. This highlights the likely benefits of a combination of surgical excision and drug therapy, in achieving a cure in this patient.

Primary cutaneous aspergillosis due toAspergillus tamariiin an immunocompetent host

“…Primary cutaneous aspergillosis may present as erythematous indurated macules, papules, plaques or haemorrhagic bullae, which may progress to necrotic ulcers that are covered by black eschar, nodular and pustular lesions or subcutaneous abscesses 9 10…”

“…Our patient being a farmer working bare foot in fields acquired this from the soil following a trauma to the right leg 9 11 12. The widespread distribution and morphology of the lesion misled the dermatologist for erythema nodosum leprosum but mycological and histological examination confirmed the diagnosis.…”

“…The most frequent causative organisms that cause cutaneous aspergillosis are A spergillus fumigatus , A spergillus flavus , A spergillus terreus , Aspergillus niger and A spergillus ustus 6–8. Primary cutaneous infection especially in immunocompetent patients is extremely rare but an increase in prevalence has been noted in the last 20 years 5 9 10. Primary cutaneous aspergillosis usually involves sites of skin injury or near intravenous access catheter sites at sites of traumatic inoculation or occlusive dressing due to surgery.…”

“…We present a case of a primary cutaneous aspergillosis caused by A tamarii in an immunocompetent farmer with erythematous nodular and plaque-like lesions mimicking erythema nodosum leprosum 8 9…”

Aspergillosis of the bone

“…Aspergillosis of the skin has however been reported in the immunocompetent patient. [6] In general, aspergillosis of the bone is very rare even in the immunocompromised, accounting for about 1.8% in the most literature. [7] The azoles have remained the mainstay of treatment of invasive aspergillosis.…”