Case discusion

1. JOURNAL CLUP, ID
Dr. Naif S Saglan ,, F1

2. CASE DISCUSSION :
• 21 years , female , dx in 2008 as ALL .
• Dx and Tx in KAMC + UK and complete her chemo
therapy 2010.
• Patient got marred 2015 , and during her antenatal
care her obstetrician notice her CBC was not normal .
• Admitted again to KAMC and Dx as relapsed with
different type of leukemia as AML.
• She received chemo therapy 3 cycle . ( 25/06/2015
to 2/07/2015 ).

3. Cont.
• Her chemo postponed after delivery .
• During her chemo therapy course patient
developed a skin lesion on her RT arm , on the
extensor surface , round in shape , red walls with
pus and discharge and foul smiling associated
with itching and high grade fever (38C -39C), no
other lesions .
• Last cycle was (21-24 /08/2015) .

5. Cont. .
• Fever 38, intermittent pattern relived by anti pyritic
associated with rigor and chills , bone pain , palpitations.
• No rashes .
• No cough or expectoration.
• No meningeal signs or abnormal movements .
• No change of her level of conscious .
 Past Medical Hx :
Cardiac myopathy .
Skin lesion in her genitalia (2008).

6. Cont. .
 Travelling Hx :
UK for therapy
 Drug Hx :
chemotherapy , No steroids
 Blood transfusion Hx :
Several times .
 Systemic review :
Un Remarkable

7. Cont. .
Patient well , conscious, oriented , setting on the
bed .
• Vitals :
Afebrile , blood pressure: 119/73
• ENT :
No thrush
No lymphadenopathy
• Chest :
Vesicle Breathing Bilaterally , Crackles on the
bases

8. Cont. .
• CVS :
S1+S2 , No murmurs .
• Abdomen :
Soft , Sax , No Organomegaly
CNS :
Grossly Intact
• Musculoskeletal :
Un Remarkable apart of her Rt arm lesion .

9. Differential dx :
•1- Cellulitis
•2- Ecythma
•3- Ecyrhma gangrenosum
•4- ,,,,,,,,,,,,,,,,,,,,,,,

10. Investigations :
 CBC :
Thrombocytopenia
Leukopenia
KIDNEY AND LIVER PROFILE :
Normal Limit
IMAGES :
No Focus
 Cultures :
Blood
Sputum ALL NO GROWTH
Urine

11. Skin biopsy :

12. DIAGNOSIS :
Aspergillus Fumigatus

13. Treatment :
 Voriconazole
(6 mg/kg IV every 12 h for 1 day, followed by 4 mg/kg IV
every 12 h )

15.  Dermatologic Manifestations of
Aspergillosis :
 Cutaneous aspergillosis is usually a cutaneous
manifestation of disseminated infection with the
fungus Aspergillus.
 Primary cutaneous disease is rare and is most
commonly caused by Aspergillus fumigatus and
Aspergillus flavus.
 Skin lesions occur in 5-10% of patients with
disseminated aspergillosis

16. Cont. .
The most typical presentation is implantation of
the fungus following trauma, including infections
at the site of intravenous cannulas, or
venipuncture wounds.
 A fumigatus is the most common pathogen
associated with disseminated disease with
cutaneous involvement.
 A flavus or A terreus most often causes the less
frequent primary infections of the skin. Aspergillus

17. Cont. .
 Invasive aspergillosis affects people who have
weakened immune systems, such as people who
have had a stem cell transplant or organ
transplant, are getting chemotherapy for cancer,
or are taking high doses of corticosteroids.
 Cutaneous presentations of systemic
aspergillosis most frequently begin as solitary or
multiple erythematous or violaceous indurated
papules or plaques . lesions are often tender, but

19. Cont. .
 In both disseminated and limited cutaneous
aspergillosis, high-dose intravenous amphotericin
B, in traditional or liposomal form.
 Voriconazole is also approved as a first-line
agent for aspergillosis.
 Treatment options for aspergillosis include
itraconazole .

20.  Reference
 IDSA
 Up to date
 Medscape

21. THANK S FOR ATTENTION