Cutaneous Aspergilloma Caused by Aspergillus niger in an Immunocompetent Patient

An 82-year-old man presented with a growth on his scalp for 7 months. It was increasing in size despite treatment with a variety of shampoos and systemic plus topical antibiotics. It was pruritic with a burning sensation. Lately, the patient had a body weight loss of 35 pounds. Extensive work-ups for malignancy included computerized axial tomography (CAT) and examinations of the gastrointestinal and respiratory tracts; however, no etiology for this weight loss was established. This was not thought to be directly related to the scalp lesion. Work-ups for any infectious etiology, including blood cultures, were proven to be noncontributory. His past medical included chronic obstructive pulmonary disease and gastritis. He also patient had a long history of tobacco use.