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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Colony morphology of A.nidulans SRF200 after two days at 37°C
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Aspergillus nidulans. Cell nuclei-Ds red. DsRed fluorescence micrographs showing nuclear distribution in an A.nidulans germling with dsRed stained nuclei
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Cell Biology – Aspergillus nidulans. Cell nuclei-GFP. Nuclear distribution: GFP fluorescence mirographs showing fungal cell morphology and nuclear distribution in A.nidulans. GFP stained nuclei,grown at 25°C in minimal media O/N
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High resolution CT scan of chest.CT scan demonstrating remarkable bronchial wall thickening of the right main bronchus and main branches, in context of longstanding ABPA
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