Infect Chemother.  2010 Aug;42(4):244-248. 10.3947/ic.2010.42.4.244.

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

• No JH
• Yu JS
• Kim EO
• Choi HH
• Kim SH
• Kwon JC
• Lee DG
• Choi SM
• Park SH
• Choi JH
• Yoo JH
• Kim HJ
• Min WS

• KMID: 1457386
• DOI: http://doi.org/10.3947/ic.2010.42.4.244

Abstract

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.

Keyword

Cutaneous aspergillosis; Disseminated aspergillosis; Acute myeloid leukemia

MeSH Terms

Aspergillosis
Brain
Heart Valves
Hematologic Neoplasms
Humans
Immunosuppression
Invasive Pulmonary Aspergillosis
Kidney
Leukemia
Leukemia, Myeloid, Acute
Liver
Lung
Recurrence
Skin
Spleen
Thyroid Gland

Figure

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  Figure 1 Photograph of the patient showing an erythema surrounding central necrotic eschar on the left forearm.

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  Figure 2 Punch biopsied specimen of skin shows acute and chronic inflammation with hyaline, septated, and acute-angle branched hyphae invading vessels in dermis and subcutis (A) Periodic acid Schiff (H&E stain, ×400), (B) Grocott-Gomori methenamine silver (H&E stain, ×400).

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