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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Aspergillosis in the coral sea fan Gorgonia ventalina. Sea fan coral Gorgonia ventalina, Florida Keys, USA. Depth ~5 metres, showing a lesion surrounded by a band of purple tissue. Central areas of the lesion are devoid of coral tissue revealing the underlying axial skeleton. The purple areas are devoid of coral polyps and result from the increased production of purple sclerites (small, non-fused, carbonate skeletal elements). The purpled area also indicates the location of high fungal hyphal density and el
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Aspergillosis in the coral sea fan Gorgonia ventalina. In the Caribbean ond offshore USA the sea fan coral species Gorgonia ventalina is undergoing an epizootic due to Aspergillus sydowii infection. This species of Aspergillus is also known to be associated with food contamination and for opportunistic infection in humans.Taken in San Salvador, Bahamas. Bar represents 5cm. This sea fan was heavily colonized by algae.A -tumours and galls B -lesion C -purplingGalls are composed of axial skeleton and scl
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