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Dermatologic Manifestations of Aspergillosis Clinical Presentation

  • Author: Annie Chiu, MD; Chief Editor: William D James, MD  more...
 
Updated: Mar 13, 2014
 

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 Cosmetic and General Dermatologist

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

Disclosure: Received consulting fee from Temptu for consulting; Received honoraria from Galderma for consulting; Received honoraria from SkinMedica for consulting.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

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

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD Associate 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, Texas Dermatological Society

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, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

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.

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.

References
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  20. Richardson MD, Warnock DW, eds. Fungal Infection. 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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