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[A case of primary pyoderma-like aspergillosis occurring in a patient with a cervical spinal cord injury]
Aki Yoshida1, Toshiki Sato, Toshihide Akasaka
1Department of Dermatology, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate 020-8505 Japan.
Abstract:
A 65-year-old man had tetraplegia caused by a cervical spinal cord injury, and could only lie in bed with a respirator. On the 14 th day of hospitalization, a rash developed on his back. The eruption grew rapidly, and became a giant erythematous plaque with ulcer, pustules, and red papules. Direct KOH examination showed branching Aspergillus hyphae. A slide culture showed subglobose shaped vesicles with phialides. Based on these findings, the case was diagnosed as primary pyoderma-like aspergillosis caused by Aspergillus fumigatus. He was treated with bifonazole and sulfadiazine silver, and one month later no Aspergillus hyphae were observed either by direct KOH examination or by culture. The patient died about 2 months later, however, because of aggravation of his general condition. Careful observation is necessary for compromised or unmoving patients with pyoderma-like aspergillosis.
Insights
A rare case of pyoderma-like aspergillosis in a tetraplegic patient is presented. Prompt diagnosis and treatment with antifungals and antibiotics were crucial for managing this severe skin infection.
Area of Science:
- Mycology
- Dermatology
- Infectious Diseases
Background:
- Spinal cord injuries can lead to immobility and increased risk of secondary infections.
- Compromised patients require vigilant monitoring for unusual dermatological manifestations.
- Aspergillus fumigatus is an opportunistic pathogen that can cause invasive infections.
Observation:
- A 65-year-old male with tetraplegia developed a rapidly progressing erythematous plaque with ulceration and pustules on his back.
- Direct KOH examination revealed branching Aspergillus hyphae, and slide culture showed characteristic vesicles with phialides.
- The clinical presentation mimicked pyoderma, but fungal elements confirmed aspergillosis.
Findings:
- The patient was diagnosed with primary pyoderma-like aspergillosis caused by Aspergillus fumigatus.
- Treatment with bifonazole and sulfadiazine silver led to the resolution of fungal elements within one month.
- Despite successful management of the skin infection, the patient's overall condition worsened, leading to death two months later.
Implications:
- This case highlights the importance of considering fungal infections in immobilized patients with unusual skin lesions.
- Early recognition and appropriate antifungal therapy are critical for managing pyoderma-like aspergillosis.
- Close monitoring and comprehensive care are essential for improving outcomes in immunocompromised individuals.