Primary cutaneous aspergillosis in an immunocompetent child
1995; Elsevier BV; Volume: 33; Issue: 1 Linguagem: Inglês
10.1016/0190-9622(95)90041-1
ISSN1097-6787
AutoresChristen M. Mowad, Tri V. Nguyen, Christine Jaworsky, Paul J. Honig,
Tópico(s)Fungal Infections and Studies
ResumoPrimary cutaneous aspergillosis is rare and occurs mainly in immunocompromised persons with aplastic anemia, AIDS, leukemia, or other malignancies.l4We describe primary cutaneous aspergillosis in a child who had no detectable immunologic deficiency. CASE REPORTA 2 l-month-old boy had a fever of unknown origin.He had been well until 12 weeks earlier, when fever associated with a streptococcal pharyngitis developed.Thereafter he continued to have intermittent fevers.Results of the following were normal or negative: blood, urine, stool, and spinal fluid cultures; chest x-ray film; liver function tests; Epstein-Barr virus titers; cytomegalovirus titers; hepatitis A, B, and C screens; rapid plasmin reagin; Lyme titer; PPD and anergy panel; HIV; erythrocyte sedimentation rate; tests for antinuclear antibody, rheumatoid factor, and anti-DNA antibodies; CHs0 chemistry panel; bone marrow biopsy; upper gastrointestinal series; gallium scan; echocardiogram; electroencephalogram; skeletal surveys; and computed tomography of the abdomen, pelvis, and head.During evaluation a 1.2 cm hemorrhagic bulla was discovered beneath an intravenous arm board that had been applied 5 days earlier.The bulla progressed into a necrotic ulcer with a black eschar surrounded by 1 cm of violaceous erythema (Fig. 1).A biopsy was performed and the tissue sent for culture.The specimen revealed extensive deep dermal and subcutaneous inflammation with necrosis.Gomori-methenamine silver stain revealed septate branching hyphae within necrotic zones (Fig. 2).A culture subsequently grew Aspergillusfumigatus.There was no evidence of systemic involvement, and the cutaneous lesion resolved with 1 month of amphotericin treatment.Further immunologic evaluation including a nitroblue tetrazolium reduction test; mitogen studies; evaluation of T-and B-cell markers; and measurement of IgG, IgA,
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