Date: 26 November 2013
The patient was a 610 g twin male born by spontaneous normal vaginal delivery at 23 weeks and 4 days gestation. He was started on benzyl penicillin and gentamicin for sepsis. On day 3, he developed metabolic acidosis, hyponatremia, anemia, thrombocytopenia and jaundice and his antibiotics were changed to vancomycin, cefotaxime and fluconazole.
On day 10, multiple circular skin papules with white eschars were noted on his back (Figure A). A full septic screen was repeated including skin scraping and biopsy for urgent microscopy and culture. Microscopy of skin scrapes revealed fungal elements including hyphae and fruiting heads suggestive of Aspergillus spp (Figure B). Lipid amphotericin B was commenced and fluconazole was stopped. Skin scrapings on culture grew Aspergillus fumigatus. A diagnosis of primary cutaneous aspergillosis was made. The patient responded to oral posaconazole 6mg/kg/8 hourly. All lesions disappeared after 44 days and he continued with posaconazole until day 60.
Published case at Langan et al Pediatr Dermatol 2010 Jul-Aug 27 (4) 403-4
Copyright: n/a
Notes:
Images library
-
Title
Legend
-
Pigmentation of Aspergillus versicolor colonies ranged from pale green to greenish-beige, pink-green, dark green and brown. Reverse is usually reddish. The growth rate is usually slow. Cultured on Sabouraud dextrose agar with chloramphenicol.
-
A Colonies on MEA after one week; B, C conidial heads with tip of conidiophire, x920; D conidial head, x 2330; E conidial heads x920
-
A Colonies on MEA + 20% sucrose after one week; B detail of colony showing columnar conidial heads x 44 ; C conidial heads x 920; D conidia x2330
-
Cultures are grown on malt extract agar for 5-7 days at 30°C.
Light microscopy-1000x stained with lacto-phenol and cotton blue.
-
A Colonies on MEA +20% sucrose after one week; B ascomata x 40; C conidiophores x 920; D ascospores x2330; E ascoma x 230; F portion of ascoma with asci and ascospores, x 920.
