IADVL
Indexed with PubMed and Science Citation Index (E) 
 
Users online: 694 
     Home | Feedback | Login 
About Current Issue Archive Ahead of print Search Instructions Online Submission Subscribe What's New Contact  
  Navigate here 
  Search
 
   Next article
   Previous article 
   Table of Contents
  
 Resource links
   Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
   Article in PDF (118 KB)
   Citation Manager
   Access Statistics
   Reader Comments
   Email Alert *
   Add to My List *
* Registration required (free)  

 
  In this article
   References
   Article Figures

 Article Access Statistics
    Viewed6014    
    Printed96    
    Emailed2    
    PDF Downloaded229    
    Comments [Add]    
    Cited by others 6    

Recommend this journal

 


 
LETTER TO EDITOR
Year : 2005  |  Volume : 71  |  Issue : 2  |  Page : 133-134

Primary cutaneous aspergillosis


1 Departments of Dermatology Venereology and Leprosy, Rajah Muthiah Medical College & Hospital, Annamalai University, Annamalai Nagar - 608 002, India
2 Departments of Microbiology, Rajah Muthiah Medical College & Hospital, Annamalai University, Annamalai Nagar - 608 002, India
3 Departments of Pathology, Rajah Muthiah Medical College & Hospital, Annamalai University, Annamalai Nagar - 608 002, India

Correspondence Address:
P VS Prasad
88 AUTA Nagar, Sivapuri post, Annamalai Nagar - 608 002, Tamil Nadu
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0378-6323.14006

Rights and Permissions



How to cite this article:
Prasad P V, Babu A, Kaviarasan P K, Anandhi C, Viswanathan P. Primary cutaneous aspergillosis. Indian J Dermatol Venereol Leprol 2005;71:133-4

How to cite this URL:
Prasad P V, Babu A, Kaviarasan P K, Anandhi C, Viswanathan P. Primary cutaneous aspergillosis. Indian J Dermatol Venereol Leprol [serial online] 2005 [cited 2019 Nov 12];71:133-4. Available from: http://www.ijdvl.com/text.asp?2005/71/2/133/14006


Sir,



Aspergillosis is an uncommon opportunistic fungal infection caused by a variety of species of which Aspergillus fumigatus and niger are the common ones.[1] Aspergillus flavus is most commonly associated with primary cutaneous aspergillosis and Aspergillus fumigatus with disseminated disease. Aspergillosis is generally a complication of severe debilitating illnesses and occurs in patients suffering from malignancies, tuberculosis, silicosis and diabetes. It also occurs in patients who are receiving long-term corticosteroids, antibiotics or cytotoxic drugs and in immuno-compromised states.[1] Cutaneous lesions are rare in aspergillosis. Primary cutaneous aspergillosis may present as macules, papules, plaques or hemorrhagic bullae, which may progress into necrotic ulcers that are covered by a heavy black eschar.[2] Voriconazole is a new antifungal agent found to be effective in aspergillosis.[3],[4] We report a case of primary cutaneous aspergillosis in a patient on oral corticosteroids.



A 45-year-old farmer, presented with history of multiple painful nodules over the extremities and trunk for two years. The lesions gradually increased in size and new nodules appeared in the last six months prior to admission. The patient had been diagnosed to have chronic dermatitis earlier and was taking oral prednisolone at a dose of 20 mg per day for more than a year prior to the onset of painful nodules. On examination there were multiple large and small tender nodules on the face, limbs and trunk. Over the right hand and foot the nodules measured 6 x 10 cm in size [Figure - 1]. Infiltrated, erythematous papules were seen on the nose, forehead and cheek. Similar discrete disseminated papules were seen on the trunk. Oral mucosa, palms and soles were normal. Discoloration and dystrophy were seen on the finger and toenails.



Investigation results revealed hemoglobin of 8.2 gm%; total count of 10,000 cells/cmm with 34% polymorphs, 58% lymphocytes and 8% eosinophils. ESR was 46 mm at one hour. The other investigations like blood sugar, renal and liver function tests were normal. Histopathologic examination of the nodules under H and E revealed normal epidermis with micro-abscess formation in the dermis. Special stain with Gomori's methenamine silver (GMS) demonstrated the fungus. The fungus was seen with the characteristic branching at an angle of 45o within thrombi in vessels, which was consistent with aspergillus species [Figure - 2]. Skin nodule and nail culture in SDA medium grew Aspergillus flavus. The patient was treated with oral itraconazole 200 mg bid, and partial regression was seen after a month of therapy.



Aspergillus species are among the most ubiquitous fungi, seen in soil, water, decaying vegetations and any substrate that contains organic debris. The respiratory tract is the most common primary portal of entry. After candida albicans, the aspergillus species is the second most common cause of human opportunistic fungal infection. Our patient was taking oral corticosteroids for more than one year for chronic dermatitis, which could have caused immunosuppression. Cutaneous aspergillosis has been reported earlier in two patients on high doses of corticosteroids.[5] Our patient presented with multiple cutaneous nodules with nail involvement. A larger nodule on the finger was excised. The histopathologic examination of the nodule confirmed the diagnosis and GMS stain demonstrated the fungi inside the vessel wall. Aspergillus flavus species was identified in the culture. The sites colonized by aspergillus include paranasal sinuses, the external auditory meatus and dystrophic nails.[6] In our patient, nail infection could explain the source of fungi inside the vessel wall of skin lesions. Although voriconazole has been found very effective it was not available and hence we treated the patient with itraconazole. We report this case for its interesting clinical features, rarity of occurrence and to highlight the hazards of prolonged intake of oral steroids.

 
  References Top

1.John PU, Shadomy HJ. Deep fungal infections. In: Dermatology in general medicine. Fitzpatrick TB, Eisen AZ, Wolff K, et al editors. 3rd Ed. New York: McGraw - Hill; 1987. p. 2266-8.  Back to cited text no. 1      
2.Longley BJ. Fungal diseases. In: Lever's Histopathology of the Skin, David Elder, Elenitsas R, and Jaworsky C, et al editors. 8th Ed. Philadelphia: Lippincott Raven; 1997. p. 525-6.  Back to cited text no. 2      
3.Clancy CJ, Nguyen MH. In vitro efficacy and fungicidal activity of voriconazole against aspergillus and Fusarium species. Euro J Clin Microbiol Infect Dis 1998;17:573-5.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]  
4.Chandrasekar PH, Manavathu E. Voriconazole: A second generation triazole. Drugs Today 2001;37:135-48.  Back to cited text no. 4      
5.Galimberti R, Kowalczuk A, Hidalgo PI, Gonzalez RM, Flores V. Cutaneous Aspergillosis: A report of six cases. Br J Dermatol 1998;139:522-6.  Back to cited text no. 5      
6.Roberts SO, Hay RJ, Mackenzie DW. A clinician's guide to fungal disease. New York: Marcel Dekker; 1984. p. 162-70.  Back to cited text no. 6      


    Figures

  [Figure - 1], [Figure - 2]

This article has been cited by
1 Morphological Findings of Deep Cutaneous Fungal Infections
Angel Fernandez-Flores,Marcela Saeb-Lima,Roberto Arenas-Guzman
The American Journal of Dermatopathology. 2014; 36(7): 531
[Pubmed] | [DOI]
2 Crusted Pustular Lesions After Cryotherapy
Á. Palomo-Arellano,I. Cervigón-González,F. Idrovo-Mora,L.M. Torres-Iglesias
Actas Dermo-Sifiliográficas (English Edition). 2012; 103(4): 333
[Pubmed] | [DOI]
3 Lesiones costrosas y pustulosas después de aplicar crioterapia
Á. Palomo-Arellano, I. Cervigón-González, F. Idrovo-Mora, L.M. Torres-Iglesias
Actas Dermo-Sifiliográficas. 2011;
[VIEW] | [DOI]
4 More experiences with the Tzanck smear test: Cytologic findings in cutaneous granulomatous disorders
Durdu, M., Baba, M., Seçkin, D.
Journal of the American Academy of Dermatology. 2009; 61(3): 441-450
[Pubmed]
5 More experiences with the Tzanck smear test: Cytologic findings in cutaneous granulomatous disorders
Murat Durdu,Mete Baba,Deniz Seçkin
Journal of the American Academy of Dermatology. 2009; 61(3): 441
[Pubmed] | [DOI]
6 Cutaneous and eyes Aspergillus fumigatus infection
Kang, E.-X., Wu, J.-Y., Wang, G.-Y., Wang, F.-S., Gao, D., Xia, X.-J., Yao, X.-P.
Chinese Medical Journal. 2008; 121(22): 2366-2368
[Pubmed]



 

Top
Print this article  Email this article
Previous article Next article

    

Online since 15th March '04
Published by Wolters Kluwer - Medknow