Primary Disseminated Pulmonary Aspergillosis With Metastatic Skin Nodules

Vedder, James S.

doi:10.1001/jama.1969.03160210023006

Cited by 44 publications

(10 citation statements)

References 7 publications

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“…When the pustule is opened purulent material can be recovered. 13 We were unable to detect antibodies against Aspergillus species or Aspergillus-antigen in either of our patients. This phenomenon has also been reported by Saugier-Veber et al 5 and is due to the profound immunosuppression, to irregular and transient excretion of Aspergillus-antigen and/or the formation of undetectable immune complexes.…”

Section: Discussioncontrasting

confidence: 60%

Skin involvement as the first manifestation of systemic aspergillosis in patients after allogeneic hematopoietic cell transplantation

Schimmelpfennig

Naumann

Zuberbier

et al. 2001

Bone Marrow Transplant

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Summary:Skin involvement due to a systemic infection with Aspergillus species in the course of allogeneic hematopoietic cell transplantation is extremely rare. We report the clinical course of two patients with hematologic malignancies who underwent allogeneic hematopoietic cell transplantation (HCT) and developed disseminated skin involvement as the first clinical symptom of a proven systemic Aspergillus infection. Bone Marrow Transplantation (2001) 27, 753-755. Keywords: cutaneous Aspergillus infection; HCT; BMT; STX; skin infection Aspergillus species are increasingly recognized as major fungal pathogens in severely immunosuppressed or neutropenic patients, particularly after allogeneic hematopoietic cell transplantation (HCT). 1 The risk of developing systemic Aspergillus infection increases with the duration of immunosuppression. The most common manifestation of an Aspergillus infection in these patients is invasive pulmonary aspergillosis characterized by hyphal invasion and destruction of pulmonary tissue. 2,3 Hematogenous dissemination as a secondary event occurs in 20-50% of these patients and most commonly involves the central nervous system and the gastrointestinal tract. 4 The overall mortality is up to 82% and reflects the clinical importance of Aspergillus infection in immunosuppressed or neutropenic patients. 5 Solitary extrapulmonary Aspergillus infection occurs most frequently in the maxillary sinuses 6,7 and colonization of the nasal sinuses can lead to endogenous spread to the lungs causing invasive pulmonary aspergillosis. The skin is a rare site of infection, 8 and cutaneous infections are most often found at the entry site of Hickman catheters. 4,7,9,10 Cutaneous aspergillosis is a poorly described entity Case report No. 1A 50-year-old male with Philadelphia-positive chronic myeloid leukemia in accelerated phase received a non-T cell-depleted bone marrow graft (1.2 × 10 8 MNC/kg BW) from his HLA-identical, MLC-negative brother. He was conditioned with busulfan (10 mg/kg), thiotepa (750 mg/kg) and cyclophosphamide (120 mg/kg) and received methotrexate and cyclosporine as GVHD prophylaxis. On day −1 twice daily prophylactic aerosol inhalation of 10 mg amphotericin B was started. On day +2 he developed fever of unknown origin and was empirically treated with a combination of cefotaxim, piperacillin and vancomycin. Because there was no resolution of the fever, intravenous (i.v.) amphotericin B was started at a dose of 0.8 mg/kg/day on day +4. On day +9 a round warm red swelling resembling a small furuncle appeared on the right thigh. This lesion grew rapidly and was extremely painful. On day +13 this lesion measured approximately 5 cm in diameter and in the centre a circular area of necrosis, 2 cm in diameter, had developed (Figure 1). Until that time microbiological examination of multiple blood cultures had yielded no positive result. Necrotic tissue from the lesion on the right thigh was sent for microbiological culture and histological examination. Both microbiological and histological exa...

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Section: Discussioncontrasting

confidence: 60%

Skin involvement as the first manifestation of systemic aspergillosis in patients after allogeneic hematopoietic cell transplantation

Schimmelpfennig

Naumann

Zuberbier

et al. 2001

Bone Marrow Transplant

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“…The clinical features of patients 1 and 2 suggested a carcinoma of the bronchus; the patients presented with cough, haemoptysis, and loss of weight, and in addition patient 2 had multip'le skin nodules simulating metastases. Disseminated aspergillosis, with nodules in the skin, was reported previously by Vedder and Schorr (1969).…”

Section: Discussionmentioning

confidence: 89%

Pulmonary aspergillosis caused by Aspergillus flavus

Mahgoub

Hassan

1972

Thorax

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“…The antifungal compound 5-fluorocyto sine (5-FC) has demonstrated growth inhibi tory activity against pathogenic yeasts [3,15,24] as well as some filamentous organ isms [2,5], In recent years, the mode of ac tion of 5-FC has been extensively studied in Saccharomyces cerevisiae [6,7,9,17] and Candida albicans [16,18,20]. Once 5-FC enters the yeast cell by a permease which also recognizes cytosine, hypoxanthine and adenine [17], it is rapidly deaminated to 5-fluorouracil (5-FU).…”

Section: Introductionmentioning

confidence: 99%

Studies on the Mode of Action of 5-Fluorocytosine in <i>Aspergillus</i> Species

Wagner¹,

Shadomy²

1979

Chemotherapy

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The mode of action of 5-fluorocytosine (5-FC) was studied in three isolates of pathogenic Aspergillus with varying degrees of susceptibility to the drug. Distribution studies showed that susceptibility or resistance to 5-FC was not dependent on uptake of the drug. While only a small percentage of the total 5-FC taken up was found in the RNA fraction of the cells, most remained in the acid-soluble intracellular pool. 5-FC, 5-fluoro-uracil (5-FU) and 5-fluorodeoxyuridine monophosphate (5-FdUMP) were among metabolites identified in the pool. In addition, fluoroorotic acid appeared to be a major constituent of the metabolites derived from 5-FC. The aspergilli also were capable of utilizing cytosine as a nitrogen source and this is suggested as a possible mechanism of resistance. A dual mode of action for 5-FC in the aspergilli is proposed. This consists of, first, incorporation of 5-FU into RNA and, second, inhibition of DNA synthesis by production of 5-FdUMP.

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Primary Disseminated Pulmonary Aspergillosis With Metastatic Skin Nodules

Cited by 44 publications

References 7 publications

Skin involvement as the first manifestation of systemic aspergillosis in patients after allogeneic hematopoietic cell transplantation

Skin involvement as the first manifestation of systemic aspergillosis in patients after allogeneic hematopoietic cell transplantation

Pulmonary aspergillosis caused by Aspergillus flavus

Studies on the Mode of Action of 5-Fluorocytosine in <i>Aspergillus</i> Species

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