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Severe Cutaneous Aspergillosis in a Neonate With Extremely Low Birth Weight: A Case Requiring Multiple Surgical

Lauren Ridgway, Julianna Diddle, Kathryn King

    Pediatric Annals
    |March 31, 2025
    PubMed

    Insights

    Extremely low birth weight infants face high risks of fungal infections. This case highlights a rare, severe cutaneous Aspergillus fumigatus infection in a premature infant, emphasizing the need for high suspicion and early treatment.

    Area of Science:

    • Neonatal Medicine
    • Infectious Diseases
    • Dermatology

    Background:

    • Fungal infections pose significant risks to neonates, particularly premature and extremely low birth weight (ELBW) infants.
    • ELBW infants are vulnerable due to immature immune systems, fragile skin, antibiotic use, central catheters, and corticosteroid therapy.
    • While Candida species are the most common cause of invasive fungal infections in neonates, other fungi like Aspergillus are rare.

    Purpose of the Study:

    • To report a rare case of severe cutaneous Aspergillus fumigatus infection in an extremely low birth weight infant.
    • To underscore the importance of early diagnosis and treatment of invasive fungal infections in high-risk neonates.
    • To increase awareness of primary cutaneous aspergillosis as a potential diagnosis in neonates with specific skin lesions.

    Main Methods:

    • Case report of an extremely low birth weight infant (23 weeks' gestation) with severe cutaneous Aspergillus fumigatus infection.
    • Description of the clinical course, including the need for multiple surgical debridement procedures.
    • Review of diagnostic considerations and management strategies for invasive fungal infections in neonates.

    Main Results:

    • The infant, born at 23 weeks' gestation, developed a severe cutaneous Aspergillus fumigatus infection.
    • The infection necessitated multiple surgical debridement procedures.
    • The case illustrates the challenges in diagnosing and managing rare fungal infections in extremely vulnerable neonates.

    Conclusions:

    • Invasive fungal infections, including rare Aspergillus species, require a high index of suspicion in high-risk neonates.
    • Primary cutaneous aspergillosis should be considered in ELBW infants presenting with rapidly progressing ulcerative or necrotic skin lesions.
    • Prompt identification and early, aggressive treatment are crucial for improving outcomes in neonatal fungal infections.

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