This document discusses the case of a 21-year-old female patient with a history of acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) who developed a skin lesion on her arm during chemotherapy treatment for AML relapse. Skin biopsy revealed infection with Aspergillus fumigatus. She was diagnosed with cutaneous aspergillosis and treated intravenously with voriconazole. Cutaneous aspergillosis is a rare manifestation of disseminated infection most commonly caused by A. fumigatus in immunocompromised patients, with skin lesions occurring in 5-10% of cases. Treatment involves intravenous antifungal drugs such as amphotericin B

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