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
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This photo shows extensive infection of the burn wound on the leg of a 7 year old boy, acquired about 3 weeks after the injury. Despite medical therapy he died.
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This patient, had had a laparostomy for recurrent intra-abdominal sepsis following on from crohns disease. She was transferred to another intensive care unit and her dressings changed daily. Shortly after, this dark patches appeared on her liver (as seen here A) and her colon. Superficial biopsies and culture showed A.fumigatus invading liver capsule. She responded to amphotericin B therapy.
B shows patient after treatment.
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Hepatic aspergillosis, pt KO. Repeat CT scan of the liver showing almost complete resolution of lesions on itraconazole therapy.
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Image A. The CT scan of her abdomen had the appearances shown here. She also has small pulmonary nodules. Bioposy of the liver revealed hyphae consistent with Aspergillus.
Image B. She responded well to oral itraconazole therapy.
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This image shows the pelvis of the left kidney filled with fungal balls. Eventually, after failing amphotericin B therapy, she required a nephrectomy. Her case is reported in Davies SP, Webb WJS, Patou G, Murray WK, Denning DW. Renal aspergilloma – a case illustrating the problems of medical therapy. Nephrol Dial Transplant 1987; 2: 568-572.
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Aspergillus keratitis. Good example of Aspergillus keratitis caused by A.glaucus. Usually A.fumitagus and A.flavus are the causes.
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