Date: 26 November 2013
This patient with ABPA and chronic cavitary pulmonary aspergillosis has been stabilized on voriconazole treatment for >5 years. She had a degree of photosensitivity most of that time, noticed early in the course of voriconazole treatment. She is oxygen and wheelchair dependent and doesn’t go outside very much, so most of her light exposure has been indoor light. She developed rough scaly patches over her face, neck and lower arms. Dermatological review indicated multiple solar keratoses”. Skin biopsy from the right forearm confirmed this clinical diagnosis – “skin showing hyperkeratosis with a little parakeratosis and acanthosis. The keratinocytes have a glassy appearance but show nuclear atypia with dyskeratotic cells, and occasional suprabasal mitoses. The intraepidermal sweat ducts are spared. Appearances suggest an actinic keratosis with moderate to severe dysplasia.” These features are characteristic of a low grade premalignant change.
She was treated with local 5-fluorouracil cream (Efudix) (3 cycles) to the affected lesions. These photos were taken at the apogee of inflammation. The inflammation resolved after discontinuing the cream. This reaction is expected with application of this mild chemotherapy agent. Alternative or supplementary treatments include cryotherapy, curettage and cautery, if necessary. Following treatment her skin was much softer and considerably improved. Voriconazole has been stopped, and posaconazole substituted.
Copyright:
DW Denning and JE Ferguson, University Hospital of South Manchester. 22/07/08
Notes: n/a
Images library
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Test for aflatoxin B1. Standard curve wells in triplicate – columns 9, 10 & 11 – laid out horizontally. Triplicates of 14 samples laid out vertically in rows 2 to 8
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Light microscopical appearance of hepatic tissue in outbreak of aflatoxicosis showing centrilobular degeneration of hepatocytes with vacuolated cytoplasm and apoptoses (top right abnormal)(Haematoxylin and eosin).
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Aspergillus terreus Thom. A Colonies on MEA after one week; B detail of colony showing columnar conidial heads x 44 ; C conidial heads and tip x 920; D conidia x2330
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Aspergillus terreus Thom. Conidial head of Aspergillus terreus. Conidial heads are compact, columnar and biseriate. Conidiophores are hyaline to slightly yellow and smooth walled.
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