History
Patients with disseminated aspergillosis often present with febrile illness, pneumonia, or sinusitis unresponsive to antibiotics. Other possible presentations include the following:
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Gradual onset of central nervous system symptoms
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Endocarditis
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Myocarditis
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Esophageal and intestinal ulcers
Physical Examination
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. [8]
Infection with A niger in a nonhealing surgical wound in an elderly immunocompetent patient has been reported. [9]
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. [10]
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Primary cutaneous aspergillosis at a site of an intravenous catheter in a boy with leukemia.
