Fungal infections are among the most serious infectious complications in immunosuppressed patients. Primary cutaneous aspergillosis is a relatively rare manifestation and is usually described in patients with underlying malignant hematological diseases, AIDS, allogenic stem cell transplantation, solid organ transplantation, etc. We present a clinical case of a 12-year-old boy with acute lymphoblastic leukemia initially diagnosed as primary cutaneous aspergillosis caused by Aspergillus flavus. The retrospective analysis demonstrates that a small solitary pulmonary nodule could be a possible portal of entry. This means that we could consider the disease as an early stage invasive aspergillosis, which is successfully treated with voriconazole.
Van Burik JA , Colven R, Spach DH. Cutaneous aspergillosis. J Clin Microbiol. 1998;36(11):3115-21.
Walsh TJ. Primary cutaneous aspergillosis-an emerging infection among immunocompromised patients. Clin Infect Dis . 1998;27(3):453-7.
Ascioglu S, Rex JH, De Pauw B, Bennett JE, Bille J, Crokaert F, et al. Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: an international consensus. Clin Infect Dis. 2002, 34(1):7-14. doi: 10.1086/323335.
Dal T, Tekin A, Tekin R, Deveci Ö, Fırat U, Mete M, et al. Soft tissue abscess caused by Aspergillus fumigatus in an immunosuppressive patient. Eur J Gen Med. 2013;10:118-122.
Saghrouni F, Gheith S, Yaacoub A, Ammous O, Ben Abdeljelil J, Fathallah A, et al. Primary cutaneous aspergillosis due to Aspergillus flavus in a neutropenic patient. J Mycol Med. 2011; 21(4):285-8. doi: 10.1016/j.mycmed.2011.09.003.
Torrelo A, Hernández-MartÃn A, Scaglione,C Madero L, Colmenero I, Zambrano A. Primary cutaneous cspergillosis in a leukemic child. Actas Dermosifiliogr. 2007;98(4):276-8.
Darr-Foit S, Schliemann S, Scholl S, Hipler UC, Elsner P. Primary cutaneous aspergillosis - an uncommon opportunistic infection Review of the literature and case presentation. J Dtsch Dermatol Ges. 2017;15(8):839-41. doi: 10.1111/ddg.13297.
Wahidi MM, Govert JA, Goudar RK, Gould MK, McCrory DC, American College of Chest Physicians. Evidence for the treatment of patients with pulmonary nodules: when is it lung cancer?: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007;132(Suppl 3):94-107. doi: 10.1378/chest.07-1352.
Zaoutis TE, Heydon K, Chu JH, Walsh TJ, Steinbach WJ. Epidemiology, outcomes, and costs of invasive aspergillosis in immunocompromised children in the United States, 2000. Pediatrics. 2006;117(4):711-16. doi: 10.1542/peds.2005-1161.
Crassard N, Hadden H, Piens MA, Pondarré C, Hadden R, Galambrun C, et al. Invasive aspergillosis in a paediatric haematology department: a 15-year review. Mycoses. 2008;51(2):109-16.doi: 10.1111/j.1439-0507.2007.01449.x.
Steinbach WJ. Invasive aspergillosis in pediatric patients. Curr Med Res Opin. 2010; 26(7):1779-87.doi: 10.1185/03007995.2010.487793.
Greene RE, Schlamm HT, Oestmann JW, Stark P, Durand C, Lortholary O, et al. Imaging findings in acute invasive pulmonary aspergillosis: clinical significance of the halo sign. Clin Infect Dis. 2007;44(3):373-9. doi: 10.1086/509917.
Marcoux D, Jafarian F, Joncas V, Buteau C, Kokta V, Moghrabi A. Deep cutaneous fungal infections in immunocompromised children. J Am Acad Dermatol. 2009;61(5):857-64. doi: 10.1016/j.jaad.2009.02.052.
Pasqualotto AC. Differences in pathogenicity and clinical syndromes due to Aspergillus fumigatus and Aspergillus flavus. Med Mycol. 2009;47(Suppl 1): 261-70. doi: 10.1080/13693780802247702.
Lass-Flörl C, Griff K, Mayr A, Petzer A, Gastl G, Bonatti H, et al. Epidemiology and outcome of infections due to Aspergillus terreus: 10-year single centre experience. Br J Haematol. 2005;131(2):201-7. doi: 10.1111/j.1365-2141.2005.05763.x.
Mayr A, Lass-Flörl C. Epidemiology and antifungal resistance in invasive Aspergillosis according to primary disease: review of the literature. Eur J Med Res. 2011;16(4):153-7.
Marr KA, Carter RA, Crippa F, Wald A, Corey L. Epidemiology and outcome of mould infections in hematopoietic stem cell transplant recipients. Clin Infect Dis. 2002;34(7):909-17. doi: 10.1086/339202.
Patterson TF, Thompson GR 3rd, Denning DW, Fishman JA, Hadley S, Herbrecht R. Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;63(4):433-42. doi: 10.1093/cid/ciw444.
Snelders E, Van der Lee HA, Kuijpers J, Rijs AJ, Varga J, Samson RA, et al. Emergence of azole resistance in Aspergillus fumigatus and spread of a single resistance mechanism. PLoS Med. 2008;5(11):e219. doi: 10.1371/journal.pmed.0050219.
Koehler P, Hamprecht A, Bader O, Bekeredjian-Ding I, Buchheidt D, Doelken G, et al . Epidemiology of invasive aspergillosis and azole resistance in patients with acute leukaemia: the SEPIA Study. Int J Antimicrob Agents. 2017;49(2):218-223. doi: 10.1016/j.ijantimicag.2016.10.019.