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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Patient MB X rays and CT scans. Chronic calcified maxillary sinusitis, patient had a palate defect.A. fumigatus cultured.
Images A&B Plain X rays antero-posterior and lateral, pre-operatively of Pt MB aged 76 who presented with unilateral nasal stuffiness and difficulty getting dentures fitted. She had hda these symptoms for many years. A large irregular calcified mass can be seen replacing the right maxillary sinus.
Images C D & E Coronal CT scan images of Pt MB showing a completely obstructed nasal cavity bilaterally and loss of internal nasal architecture. On the right side is large lamellar calcified lesion embedded in the extensive inflammatory material. Loss of bony margins is seen in numerous locations. This material was all removed surgically and showed mostly necrotic debris with Charcot-Leyden crystals and a few eosinophils and degenerate fungal hyphae. Aspergillus fumigatus was cultured from the material, especially infero-laterally on the right.
Image F Photograph through the mouth post-operatively showing the palate and a large defect in its right side. Through the defect can be seen the interior of the right maxillary sinus and nasal cavity with the inferior turbinate just visible.
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Aspergillus keratitis. Severe aspergillus infection with large area of corneal ulceration and deep stromal involvement
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Sequence of images showing ocular surface change which unusually predisposed to severe fusarium keratitis in an elderly woman. Successful treatment involved full thickness corneal transplantation shown 2 weeks and then 2 years after surgery.
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Sequence of images showing ocular surface change which unusually predisposed to severe fusarium keratitis in an elderly woman. Successful treatment involved full thickness corneal transplantation shown 2 weeks and then 2 years after surgery.
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Sequence of images showing ocular surface change which unusually predisposed to severe fusarium keratitis in an elderly woman. Successful treatment involved full thickness corneal transplantation shown 2 weeks and then 2 years after surgery.
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Sequence of images showing ocular surface change which unusually predisposed to severe fusarium keratitis in an elderly woman. Successful treatment involved full thickness corneal transplantation shown 2 weeks and then 2 years after surgery
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Aspergillus keratitis. Shrunken eye as a consequence of this infection
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