Pt LA Preterm neonate with primary cutaneous aspergillosis, successful treatment with posaconazole.

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

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Showing 10 posts of 2574 posts found.
  • Title

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  • Drug rashes: Drug interactions between steroids and anti-fungal drugs – (ecchymosis)

    Image A: Red skin rash on arms due to effect of inhaled steroids termed ecchymosis., Image B: Red skin rash on arms due to effect of inhaled steroids termed ecchymosis., Image C: Papular rash with blisters on the back, associated with CPA but prior to treatment, rash appeared 2 years previously in October 2007. The rash resolved on treatment with azoles., Image D: Papular rash with blisters on the back, associated with CPA but prior to treatment, rash appeared 2 years previously in October 2007. The rash resolved on treatment with azoles.

  • Reference: Muco-cutaneous retinoid effects and facial erythema related to the novel triazole antifungal agent voriconazole. Denning, DW & Griffiths, CEM. Clin.Exp Dermatol 2001, 26(8), 648-53.
    Courtesy of Dr D Denning, Wythenshawe Hospital, Manchester.(© Fungal Research Trust)

    Patient AB: Voriconazole rash. Following 8 weeks of Voriconazole, patient had remarkable facial erythema, most consistent with sun exposure because of sparing of her neck., Patient AB: Voriconazole rash. Following 8 weeks of Voriconazole, patient had remarkable facial erythema, most consistent with sun exposure because of sparing of her neck., Patient AB: Discoid lupus erythematosus following 12 months voriconazole therapy. This improved with use of sunblock factor 30 and resolved after discontinuation of voriconazole, 2 months later.

  • Micrographs of A. niger conidia & conidial heads provided by Amaliya Stepanova, Head of Laboratory pathomorphology and cytology at Kashkin Research Institute, Russian Federation.

    A niger conidial head TEM in vitro (РКПГF-1124), A niger mature conidium TEM in vitro (РКПГF-1124)

  • Micrographs of A. terreus conidia & conidial heads provided by Amaliya Stepanova, , Head of Laboratory pathomorphology and cytology at Kashkin Research Institute, Russian Federation.

    A terreus aleurospore TEM in vitro (РКПГF-1275), A terreus mature conidium SEM in vitro (РКПГ-1275), A terreus mature conidial head SEM in vitro

  • Micrographs of A. fumigatus conidia & conidial heads provided by Amaliya Stepanova, , Head of Laboratory pathomorphology and cytology at Kashkin Research Institute, Russian Federation.

    Conidial head (SEM), Part of conidial head (SEM), Mature conidia (SEM), Hyphae (SEM), Murine lung tissue (TEM)

  • Isolate from environmental sample

    A. clavatus, A. clavatus, A. clavatus

  • Patients has history of ABPA complicating long standing asthma. His total IgE has fluctuated between 2,200 and 4,600 KU/L, his Aspergillus IgE between 36.3 and 65.4 kAU/L and Aspergillus IgG from 87-154 mg/L. He has been taking long term itraconazole.

    December 2012, May 2012, AW CT Dec 2012 2, February 2010