Primary cutaneous aspergillosis, mimicking malignancy, a rare presentation in an immunocompetent patient

Abstract

Aspergillus species are ubiquitous opportunistic molds that cause both allergic and invasive syndromes. A 65-year-old female, farmer by occupation, presented with left upper limb and trunk swelling for one year, associated with pain, tightening of skin, and vesicles with watery discharge. Local examination showed a diffuse swelling extending from left arm to forearm and lateral chest wall associated with edema, induration, and raised temperature. The swelling was firm to hard with superficial skin ulcers and black eschar. Hematological investigations of the patient showed raised total WBC count and peripheral blood eosinophilia. Patient had no history suggesting immunosuppression. Clinico-radiological impression was left breast carcinoma with secondary skin involvement. fine-needle aspiration cytology (FNAC) from the swelling showed inflammatory cells, necrosis, epitheloid cell granulomas, and giant cells along with branching hyphae of variable thickness, confirmed on Gomori Methenamine Silver stain as fungal hyphae. Culture was advised which identified the species as Aspergillius fumigatus. Primary cutaneous infection by A. fumigatus in an immunocompetent patient is unheard of. FNAC has an important role in resolving diagnostic dilemma in primary cutaneous aspergillosis, which may mimic malignancy as in our case.

The Emergence of Rare Clinical Aspergillus Species in Qatar: Molecular Characterization and Antifungal Susceptibility Profiles

“…Aspergillus species are common environmental fungi found in soil and decaying vegetative materials. They can infect immunocompetent (Chaturvedi et al, 2017; Emiralioglu et al, 2017; Kumar et al, 2017; Saedi et al, 2017) and immunocompromised (Taccone et al, 2015) patients. Individuals with underlying diseases or immune deficiencies can develop a variety of symptoms ranging from allergies, bronchopulmonary infections, and bronchitis, to invasive aspergillosis (IA) (Ruping et al, 2008; Guinea et al, 2010; Sugui et al, 2014).…”

Cutaneous Aspergilosis Caused by Aspergillus Flavus: A Case Report

“…In addition, otherwise healthy hosts can develop cutaneous aspergillosis in surgical wounds, by traumatic inoculation, or by exposure to high spore counts in occupations such as farming. 6,7 The skin lesions of primary cutaneous aspergillosis occurs as a result of direct inoculation of Aspergillus spores at the site of injury. It may present most commonly on the extremities with several form.…”

Aspergillus fumigatus as an agent of cutaneous aspergillosis in immunocompetent patient: A rare case

“…Aspergillus species is a saprophytic mold, which is found in decaying organic matter. Infection occurs by inhalation of spores or by direct entry of organisms into body tissue through wound 2 .…”

“…Primary cutaneous aspergillosis usually involves sites of skin injury, at or near intravenous access catheter sites, at sites of traumatic inoculation, and at sites associated with occlusive dressings, burns, or surgery. 1,2 Numerous reports have described primary or secondary cutaneous aspergillosis in an array of non-HIV-infected immunocompromised patients, including burn victims, neonates, individuals with cancer, and bone marrow and solid-organ transplant recipients. 2 Primary cutaneous infection by Aspergillus fumigatus in an immunocompetent patient is unheard of Chaturvedi et al 2…”

“…1,2 Numerous reports have described primary or secondary cutaneous aspergillosis in an array of non-HIV-infected immunocompromised patients, including burn victims, neonates, individuals with cancer, and bone marrow and solid-organ transplant recipients. 2 Primary cutaneous infection by Aspergillus fumigatus in an immunocompetent patient is unheard of Chaturvedi et al 2…”