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Necrotic Ulcer on the Thumb of a Teenager With Leukemia—Diagnosis
Arch Dermatol. 2005;141:633-638.
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Diagnosis: Cutaneous and disseminated aspergillosis.
MICROSCOPIC AND LABORATORY FINDINGS AND CLINICAL COURSE
Medium-power microscopy showed acral skin with a hemorrhagic crust and marked epidermal and dermal necrosis. No obvious vascular thrombosis was present. Closer inspection revealed numerous septate hyphae with acute angle branching, features that were accentuated with the periodic acid–Schiff and methenamine silver stains. Cultures of the bulla fluid, resected bowel, sputum, and bronchial lavage yielded Aspergillus flavus. Blood cultures remained negative for organisms throughout the patient’s hospital course. Despite aggressive treatment with amphotericin B and fluconazole, the patient’s condition deteriorated rapidly, and she died 3 days later.
DISCUSSION
Aspergillus is a ubiquitous saprophyte that is found in soil and water and is generally nonpathogenic in immunocompetent patients.1-2 However, in immunocompromised patients, Aspergillus is second only to Candida as a cause of opportunistic fungal infections.3 Many of these patients, including ours, have leukemia with lesions developing at sites of intravenous cannulas, dressings, and tape.4-5 Normal functioning of both neutrophils and macrophages . . . [Full Text of this Article]
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Arch Dermatol. 2005;141(5):633-638.
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