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
-
Title
Legend
-
Allergic Aspergillus Sinusitis -Patient AM. D – Marked involvement of ehmoidal air cells on the right , together with the inferior aspect of the sphenoid sinus. The left side is almost clear of disease.
-
Further details
Image 1. The chest x-ray shows extensive bilateral nodular disease, most consistent with a fungal infection, or possibly tuberculosis. He was treated with a bucket face mask with 80% oxygen and voriconazole.
, 
, 
, 
, 
, 
-
A Colonies on MEA +20 % sucrose after 2 weeks; B ascomata, x 40; C conidiophore of Aspergillus glaucus x 920;D conidiophore of Aspergillus glaucus x920 E. portion of ascoma with asci x 920. F ascospores x2330.
-
Scanning electron micrographs of A. fumigatus conidia of transformants rodB-02 (b). Size bar, 100 nm.
-
Scanning electron micrographs of A. fumigatus conidia of the wild-type G10 strain (a). Size bar, 100 nm.
-
Scanning electron micrographs of A. fumigatus conidia of rodA rodB-26 (d).Size bar, 100 nm.
, 
 treatment.){kind=link}