J Korean Med Sci.  2008 Oct;23(5):920-923. 10.3346/jkms.2008.23.5.920.

Free Flap Coverage of Extensive Soft Tissue Defect in Cutaneous Aspergillosis: A Case Report

• Heo CY
• Eun SC
• Baek RM
• Minn KW

• KMID: 1783086
• DOI: http://doi.org/10.3346/jkms.2008.23.5.920

Abstract

Isolated fungal soft-tissue infections are uncommon, but may cause severe morbidity or mortality. Aspergillosis infection is rare, but the frequency in increasing over the last two decades. Here, we present a patient with utaneous aspergillosis of his right elbow with unusual clinical and radiological features suggestive of a malignant disease, which remained undiagnosed for an extended period of time. The patient presented with necrotic, black-colored skin ulcerations. We completely removed the skin ulcer with the surrounding erythematous skin lesion, and then we reconstructed the area with thoracodorsal perforator free flap. The biopsy specimen contained septate hyphae with dichotomous branching, which is morphologically consistent with a finding of Aspergillus. After surgery, we initiated antifungal medication therapy with amphotericin B and itraconazole. At the time of follow-up, the elbow with the reconstructed flap had fully healed, and no recurrent disease was found.

Keyword

Aspergillosis; Flap

MeSH Terms

Amphotericin B/therapeutic use
Antifungal Agents/therapeutic use
Aspergillosis/*therapy
Biopsy
Humans
Itraconazole/therapeutic use
Male
Middle Aged
Skin Diseases/*surgery
*Surgical Flaps
Treatment Outcome

Figure

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  Fig. 1 Primary cutaneous aspergillosis of the elbow. Note the open weeping ulcers, black necrotic eschars, and diffuse erythematous skin changes.

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  Fig. 2 Magnetic resonance imaging (fat saturated T1-enhancing) examination showed a soft tissue defect and severe muscular inflammatory infiltration around bone.

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  Fig. 3 The surrounding 2-3 cm margin of non-necrotic, erythematous skin was removed with central ulceration.

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  Fig. 4 A periodic acid-Schiff stained section of necrotic lesion. Septate hyphae are surrounded by dermal necrosis and acute inflammation (original magnification, ×40).

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  Fig. 5 Gomori methenamine silver stain (GMS) of the lesion reveals numerous spores and hyphae with a morphology consistent with aspergillosis (original magnification, ×40).

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  Fig. 6 A postoperative 2 yr view shows a completely healed flap coverage area.

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