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Neonatal Cutaneous Invasive Aspergillosis Accompanied by Hemophagocytic Lymphohistocytosis

Zhuanggui Chen1, Lifen Yang, Yating Li

  • 1From the *Department of Pediatrics and †Department of Dermatology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; ‡Institute of Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, the Netherlands; CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands; Directorate General of Health Services, Ibri Hospital, Ministry of Health, Oman; and §Department of Medical Microbiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands; Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.

The Pediatric Infectious Disease Journal
|December 16, 2016
PubMed

Insights

A rare infant fungal infection, cutaneous invasive aspergillosis, was successfully treated with amphotericin B and posaconazole. This treatment also resolved associated hemophagocytic lymphohistiocytosis, highlighting the importance of prompt diagnosis and management.

Area of Science:

  • Medical Mycology
  • Pediatric Infectious Diseases
  • Hematology

Background:

  • Cutaneous invasive aspergillosis is a rare but severe fungal infection, particularly in infants.
  • Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory syndrome.
  • Co-occurrence of these conditions presents significant diagnostic and therapeutic challenges.

Observation:

  • A 6-week-old female infant presented with invasive aspergillosis of the skin.
  • Aspergillus flavus was identified from skin lesion biopsies and confirmed molecularly.
  • The infant also exhibited signs of hemophagocytic lymphohistiocytosis.

Findings:

  • Antifungal susceptibility testing revealed potent activity of amphotericin B and triazoles against Aspergillus flavus.
  • The infant showed a positive clinical response to intravenous amphotericin B, oral posaconazole, and wound care.
  • Resolution of hemophagocytic lymphohistiocytosis was observed following successful treatment of the fungal infection.

Implications:

  • Prompt diagnosis and treatment of cutaneous invasive aspergillosis are crucial for patient survival.
  • Effective antifungal therapy can lead to the resolution of associated severe conditions like HLH.
  • This case underscores the need for vigilance in diagnosing and managing invasive fungal infections in vulnerable pediatric populations.

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