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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Single fungal ball, moving. Radiographic appearance of a fungus ball, showing movement as the patient’s position changes.
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Oxalate crystals in the cavity wall surrounding an Aspergillus niger fungus ball (H&E, dark field, x 25).
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Aspergilloma patient. Gross pathology appearance of a fungus ball.
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Conidiophores of Aspergillus fumigatus in the mass of the fungal ball surrounded by mycelia (H&E, x 400).
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Aspergillus niger fungal ball. Calcium oxalate crystals in Aspergillus niger fungal ball. Also shown are darkly pigmented, rough-walled conidia associated with Aspergillus niger infection.
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Aspergillus niger fungus ball within an old tuberculous cavern. This patient had diabetes, a disease commonly associated with A. niger infection.
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Conidial head and brown conidia in a section of a fungus ball caused by Aspergillus niger (H&E, x 400).
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