Subcutaneous Aspergillus nodule with cutaneous Enterococcus infection

An 87-year-old woman presented with a subcutaneous nodule with overlying black and yellow scales on the surface located on the left forearm. Enterococcus faecalis grew up in bacterial culture using specimen from skin surface scale. And Aspergillus fumigatus was detected in the subcutaneous tissue culture. When suspecting a deep infection, not only the surface part but also the deeper part must be cultured, because we may mislead about the identity of the infectious organism only bacterial culture form skin surface.