Cutaneous aspergillosis in a lung transplant recipient

Abstract: Organ transplant recipients are at increased risk for Aspergillus infections. Cutaneous aspergillosis (CA) occurs less frequently and is poorly characterized. The case of a lung transplant recipient with CA is presented. Six months after transplantation, 3 painful skin nodules appeared, with 1 each in the right calf, left arm, and upper back. Exudate from the leg nodule yielded Aspergillus fumigatus. Computed tomography of the chest showed bilateral hilar lymphadenopathy, but <1 cm in size. The case could be the result of Aspergillus dissemination from a hypothetical asymptomatic pulmonary infection. The lack of lung radiological signs could be related to prophylactic treatment with inhaled liposomal amphotericin B, which could have prevented clinically evident Aspergillus lung infection. The patient was treated with voriconazole, which was maintained for 3 months. The patient recovered completely.

[1]  Janet L. Hoffman,et al.  Clinical Application of Voriconazole Concentrations in the Treatment of Invasive Aspergillosis , 2008, The Annals of pharmacotherapy.

[2]  M. Haberal,et al.  Multiple subcutaneous nodules leading to the diagnosis of pulmonary aspergillosis in a renal transplant recipient , 2007, Clinical transplantation.

[3]  A. Cosimi,et al.  Cutaneous Aspergillus ustus in a lung transplant recipient: emergence of a new opportunistic fungal pathogen. , 2008, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[4]  Joan Gavaldà,et al.  Infección en el trasplante de pulmón , 2007, Enfermedades Infecciosas y Microbiología Clínica.

[5]  J. Torre-Cisneros,et al.  Risk factors for pulmonary Aspergillus terreus infection in patients with positive culture for filamentous fungi. , 2007, Chest.

[6]  J. Perfect,et al.  Evaluation and management of Fungal infections in Immunocompromised patients , 2005, Dermatologic therapy.

[7]  A. Milstone,et al.  A survey of anti-fungal management in lung transplantation. , 2004, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[8]  H. Kim,et al.  A case of primary cutaneous aspergillosis in a renal transplant recipient. , 2004, Transplantation proceedings.

[9]  Nina Singh,et al.  Opportunistic mycelial fungal infections in organ transplant recipients: emerging importance of non-Aspergillus mycelial fungi. , 2003, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[10]  N. Smedira,et al.  The incidence of invasive aspergillosis among solid organ transplant recipients and implications for prophylaxis in lung transplants , 2002, Transplant infectious disease : an official journal of the Transplantation Society.

[11]  Richard Sylvester,et al.  Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. , 2002, The New England journal of medicine.

[12]  J. Perfect,et al.  SAFETY OF AEROSOLIZED AMPHOTERICIN B LIPID COMPLEX IN LUNG TRANSPLANT RECIPIENTS12 , 2001, Transplantation.

[13]  F. Martinez,et al.  Spectrum of Aspergillus infection in lung transplant recipients: case series and review of the literature. , 2001, Chest.

[14]  William R. Kirkpatrick,et al.  Invasive Aspergillosis Disease Spectrum, Treatment Practices, and Outcomes , 2000, Medicine.

[15]  Galimberti,et al.  Cutaneous aspergillosis: a report of six cases , 1998, The British journal of dermatology.

[16]  M. Wallace,et al.  Cutaneous aspergillosis. , 1997, Cutis.

[17]  P. Itin,et al.  Outbreak of Invasive Mycoses Caused by Paecilomyces lilacinus from a Contaminated Skin Lotion , 1996, Annals of Internal Medicine.

[18]  M. Stiller,et al.  Primary cutaneous infection by Aspergillus ustus in a 62-year-old liver transplant recipient. , 1994, Journal of the American Academy of Dermatology.

[19]  E. Bouza,et al.  Surgical wound infection by Aspergillus fumigatus in liver transplant recipients. , 1992, Diagnostic microbiology and infectious disease.

[20]  H. Neu,et al.  Primary cutaneous aspergillosis in six leukemic children. , 1985, Journal of the American Academy of Dermatology.