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George J. Murakawa, MD, PhD; Jeff D. Harvell, MD; Paul Lubitz, MD; Sanford Schnoll, MD; Sue Lee, MD; Timothy Berger, MD

Arch Dermatol. 2000;136:365-369.

Background  Primary cutaneous aspergillosis is an uncommon finding in patients with acquired immunodeficiency syndrome (AIDS); only 13 cases have been reported in the literature.

Observations  We describe 11 patients with primary cutaneous aspergillosis and AIDS. There does not seem to be an age, sex, race, or human immunodeficiency virus risk factor predisposition. This is a late manifestation of AIDS; patients typically have low CD4 counts (<0.050 x 10⁹/L [<50/µL]) and other AIDS-defining illnesses. The most frequent presentation is in patients with cytomegalovirus disease and neutropenia caused by ganciclovir therapy. Lesions developed at the site of occlusive dressings for an indwelling intravenous catheter site in 10 patients. Neutrophil counts may be normal at the time of diagnosis. A minor presentation is in the patient without neutropenia as a result of traumatic inoculation. Histological findings and/or culture results are required for diagnosis. Patients develop cutaneous lesions despite prophylactic therapy with fluconazole. Lesions can be treated with excision and lifelong therapy with itraconazole.

Conclusion  Because of the potential morbidity and mortality of cutaneous aspergillosis, a high level of suspicion and prompt institution of therapy is required.

From the Departments of Dermatology, University of California, San Francisco (Drs Murakawa, Lubitz, Lee, and Berger) and Davies Medical Center (Dr Schnoll), San Francisco, Calif; the Division of Dermatology, Albany Medical College, Albany NY (Dr Murakawa); and Stanford University School of Medicine, Stanford, Calif (Dr Harvell).

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