Dermatologic Manifestations of Aspergillosis Clinical Presentation

  • Author: Annie Chiu, MD; Chief Editor: William D James, MD   more...
 
Updated: May 11, 2012
 

History

Patients with disseminated aspergillosis often present with febrile illness, pneumonia, or sinusitis unresponsive to antibiotics. Other possible presentations include the following:

  • Gradual onset of central nervous system symptoms
  • Endocarditis
  • Myocarditis
  • Esophageal and intestinal ulcers
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Physical

The pertinent physical findings of cutaneous aspergillosis as described below are limited to the skin examination.

Cutaneous presentations of systemic aspergillosis most frequently begin as solitary or multiple erythematous or violaceous indurated papules or plaques. The lesions are often tender, but they can be asymptomatic. These manifestations evolve rapidly into centrally placed pustules, hemorrhagic vesicles, and, ultimately, black eschars. Involved areas can be large or small, can be localized or diffuse, and most often arise on the limbs and head. Truncal lesions are much less common.

Primary cutaneous infections usually develop at the sites of an intravenous catheter or a venipuncture. Reports have also associated the use of occlusive dressings, armboards, nonsterile gauze, plaster casts, and adhesive tape with primary cutaneous aspergillosis.[4]

Infection with A niger in a nonhealing surgical wound in an elderly immunocompetent patient has been reported.[5]

Skin lesions often initially appear as a localized cellulitis that develops into the typical necrotic ulcer or a black eschar. Aspergillus chevalieri has been reported to cause a distinct skin lesion that is more hyperkeratotic and vesiculopapular in nature.[6]

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Causes

Aspergillosis is an uncommon disease in patients who are not immunocompromised because normal neutrophilic and macrophagic functions prevent infection; however, any deficiency in these immunologic parameters increases the risk of aspergillosis. For example, systemic corticosteroid therapy is a known risk factor for cutaneous aspergillosis. Secondary cutaneous aspergillosis has been reported in an asthma patient on 1 month of steroid treatment.[7]

Some environmental risk factors have also been implicated in cutaneous aspergillosis; these factors include construction sites and contaminated ventilation systems, presumably caused by effects on spore distribution.

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Contributor Information and Disclosures
Author

Annie Chiu, MD  Dermatologist, Murad Medical Group

Annie Chiu, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, and Women's Dermatologic Society

Disclosure: Temptu Consulting fee Consulting; Galderma Honoraria Consulting; SkinMedica Honoraria Speaking and teaching

Coauthor(s)

Alexa F Boer Kimball, MD, MPH  Associate Professor of Dermatology, Harvard University School of Medicine; Vice Chair, Department of Dermatology, Massachusetts General Hospital; Director of Clinical Unit for Research Trials in Skin (CURTIS), Department of Dermatology, Massachusetts General Hospital

Alexa F Boer Kimball, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Peter Fritsch, MD  Chair, Department of Dermatology and Venereology, University of Innsbruck, Austria

Peter Fritsch, MD is a member of the following medical societies: American Dermatological Association, International Society of Pediatric Dermatology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD  Assistant Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD  Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

References

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  2. Zhang QQ, Li L, Zhu M, Zhang CY, Wang JJ. Primary cutaneous aspergillosis due to Aspergillus flavus: a case report. Chin Med J (Engl). Feb 5 2005;118(3):255-7. [Medline].

  3. Mohapatra S, Xess I, Swetha JV, et al. Primary cutaneous aspergillosis due to Aspergillus niger in an immunocompetent patient. Indian J Med Microbiol. Oct-Dec 2009;27(4):367-70. [Medline].

  4. Larkin JA, Greene JN, Sandin RL, Houston SH. Primary cutaneous aspergillosis: case report and review of the literature. Infect Control Hosp Epidemiol. Jun 1996;17(6):365-6. [Medline].

  5. Robinson A, Fien S, Grassi MA. Nonhealing scalp wound infected with Aspergillus niger in an elderly patient. Cutis. Apr 2011;87(4):197-200. [Medline].

  6. Naidu J, Singh SM. Aspergillus chevalieri (Mangin) Thom and Church: a new opportunistic pathogen of human cutaneous aspergillosis. Mycoses. Jul-Aug 1994;37(7-8):271-4. [Medline].

  7. Kim CW, Seo JS, Kim MK, Jun EJ, Choi JC, Choi BW. Secondary cutaneous aspergillosis disseminated from the lungs of a patient with asthma on 1 month steroid treatment. Diagn Microbiol Infect Dis. Jan 2010;66(1):104-7. [Medline].

  8. Wheat LJ. Rapid diagnosis of invasive aspergillosis by antigen detection. Transpl Infect Dis. Dec 2003;5(4):158-66. [Medline].

  9. Krishnan-Natesan S, Chandrasekar PH, Manavathu EK, Revankar SG. Successful treatment of primary cutaneous Aspergillus ustus infection with surgical debridement and a combination of voriconazole and terbinafine. Diagn Microbiol Infect Dis. Dec 2008;62(4):443-6. [Medline].

  10. Cooke FJ, Terpos E, Boyle J, Rahemtulla A, Rogers TR. Disseminated Aspergillus terreus infection arising from cutaneous inoculation treated with caspofungin. Clin Microbiol Infect. Dec 2003;9(12):1238-41. [Medline].

  11. Koss T, Bagheri B, Zeana C, Romagnoli MF, Grossman ME. Amphotericin B-resistant Aspergillus flavus infection successfully treated with caspofungin, a novel antifungal agent. J Am Acad Dermatol. Jun 2002;46(6):945-7. [Medline].

  12. Klein KC, Blackwood RA. Topical voriconazole solution for cutaneous aspergillosis in a pediatric patient after bone marrow transplant. Pediatrics. Aug 2006;118(2):e506-8. [Medline].

  13. Cabral C, Francisco V, Cavaleiro C, et al. Essential Oil of Juniperus communis subsp. alpina (Suter) Celak Needles: Chemical Composition, Antifungal Activity and Cytotoxicity. Phytother Res. Feb 1 2012;[Medline].

  14. [Guideline] Walsh TJ, Anaissie EJ, Denning DW, et al. Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis. Feb 1 2008;46(3):327-60. [Medline].

  15. Herbrecht R, Denning DW, Patterson TF, Bennett JE, Greene RE, Oestmann JW, et al. Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med. Aug 8 2002;347(6):408-15. [Medline].

  16. Walsh TJ, Raad I, Patterson TF, et al. Treatment of invasive aspergillosis with posaconazole in patients who are refractory to or intolerant of conventional therapy: an externally controlled trial. Clin Infect Dis. Jan 1 2007;44(1):2-12. [Medline].

  17. Elder D, Elenitsas R, Jaworsky C, eds. Lever's Histopathology of the Skin. Philadelphia, Pa: Lippincott-Raven; 1997:525-6.

  18. Freedberg I, Eisen AZ, Wolff K, et al, eds. Fitzpatrick's Dermatology in General Medicine. 5th ed. New York, NY: McGraw-Hill; 1999:1436-7.

  19. Odom RB, James WD, Berger TG, eds. Andrews' Diseases of the Skin. Philadelphia, Pa: WB Saunders; 2000:415.

  20. Richardson MD, Warnock DW, eds. Fungal Infection. In: Diagnosis and Management. 2nd ed. Blackwell Science: Oxford, England; 1997:113-30.

 
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Primary cutaneous aspergillosis at a site of an intravenous catheter in a boy with leukemia.
 
 
 
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