Primary Cutaneous Aspergillosis in a Patient With a Solid Organ Transplant: Case Report and Review of the Literature
Primary cutaneous aspergillosis is an uncommon disease in immunocompetent individuals that often affects immunosuppressed hosts. We present the first reported case of primary cutaneous aspergillosis in a solid organ transplant recipient caused by Aspergillus niger. Fruiting bodies were isolated from a necrotic ulcer arising in a surgical wound. Debridement alone failed to resolve the infection, emphasizing the need for early antifungal treatment combined with surgical management of this infection.
Successful treatment of primary cutaneous aspergillosis requires a high index of suspicion, with early diagnosis and aggressive management. Primary cutaneous aspergillosis should be considered in the differential diagnosis of necrotizing skin lesions and nonhealing surgical wounds in immunosuppressed patients. Maximized immunosurveillance is critical and immunosuppressive medications should be decreased or discontinued if possible. Necrotic tissue requires debridement. However, as demonstrated in our patient, debridement alone may be insufficient for eradication of the infection, especially in immunocompromised patients. Antifungal antibiotics should be administered as soon as possible. The classic antimicrobial drug of choice is intravenous ampho- tericin Β.2,3,19,20 This drug is fungicidal both in vitro and in vivo, with a low incidence of resistance.21,22 However, studies have shown better survival rates with voriconazole compared with amphotericin Β as initial therapy for invasive aspergillosis.23,24 Caspofungin combined with voriconazole also has been shown to be particularly effective as initial treatment of invasive aspergillosis in solid organ transplant recipients with renal dysfunction or A fumigatus infections.25
