Coexistent cutaneous Aspergillus and cytomegalovirus infection in a liver transplant recipient

Cutaneous infections are a significant cause of morbidity in solid organ recipients. These infections may be complex with multiple pathogens occurring in the same lesion. We describe the unusual association of cutaneous Aspergillus and cytomegalovirus (CMV) infections in a liver transplant recipient. Cutaneous CMV infection is rare and often indicates severe systemic involvement, whereas Aspergillus is a frequent cause of opportunistic cutaneous fungal infection. Seven weeks after liver transplantation, our patient had hemorrhagic, eroded plaques develop on his arms. The results of routine histology, immunoperoxidase staining for CMV antibody, and fungal culture revealed coexistent cutaneous Aspergillus flavus and CMV infections. The patient was treated with ganciclovir, amphotericin B, and topical terbinafine cream; however, 2 weeks after the development of the cutaneous lesions, the patient died.