Aspergillus nidulans causing primary cutaneous aspergillosis in an immunocompetent patient.

To the Editor: Cutaneous aspergillosis mostly has been reported in immunosuppressed hosts and usually is caused by Aspergillus flavus or Aspergillus fumigatus. We report the occurrence of primary cutaneous aspergillosis (PCA) caused by a relatively rare species, Aspergillus nidulans, in a middle-aged patient without overt immunosuppression or history of trauma. A 57-year-old woman was referred to the dermatology outpatient department for evaluation of a lesion on the right hand of 1 month’s duration. On examination the lesion measured approximately 43 cm with central necrosis (Figure 1). Her medical history was unremarkable and routine laboratory test results were within reference range. The patient was an agricultural worker with no history of trauma. Her history was unremarkable. A 20% potassium hydroxide mount of the tissue revealed septate, branched, hyaline hyphae. A soft, wooly, greenish brown growth was observed after 3 days of incubation on Sabouraud dextrose agar (Figure 2). No growth was observed on dermatophyte test medium. A lactophenol cotton blue mount revealed columnar conidial heads with brown, short, smooth-walled conidiophores (Figures 3–6). Vesicles were hemispheric and small (8–12 μm in diameter), with metulae and phialides occurring in the upper portion. Conidia were globose (3–4 μm) and rough. Based on these findings the fungus was identified as A nidulans. The patient did not respond to daily