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
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Falcons: The following images were obtained by endoscopy of falcons with aspergillosis.A,B Thoracic airsac (T) with prominent blood vessels and a dead serratospiculum worm (W). The presence of these lung worms makes the airsac look milky. D Normal ovary with developing follicles.
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Falcons: The following images were obtained by endoscopy of falcons with aspergillosis.B,D Aspergillus lesions (A) over a swollen liver
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Falcons: The following images were obtained by endoscopy of falcons with aspergillosis.B Cranial, middle, caudal lobes (K1,K2,K3) of the left kidney, all the lobes show slight nephromegaly.C Yellow aspergillus colony (A1), lying adjacent to the lung.D White aspergillus colonies (A2,A3,A4).
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Falcons: The following images were obtained by endoscopy of falcons with aspergillosis.C Cranial pole of left kidney (K) -mildly inflamed.D Ovary ( F) with developing follicles.
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The following images were obtained by endoscopy of falcons with aspergillosis.A and B Lung Worm (S) over liver (Li) (serratospiculum seurati)C and D Aspergilloma (A) and prominent blood vessels on the caudal thoracic air sac (T).
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The following images were obtained by endoscopy of falcons with aspergillosis. A Lung Worm (serratospiculum sp.) B Lying in betweeen loops of the intestine.C An aspergillus lesion in between the loops of the intestineD Showing cranial pole of left kidney, ovary and oviduct.
