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Surgical wound healing complicated by Aspergillus infection in a nonimmunocompromised host
L L Anderson1, M B Giandoni, R A Keller
1Dermatology Service, Brooke Army Medical Center, Fort Sam Houston, Texas, USA.
Background:
An unusual complication of cutaneous surgery and its management is presented. Aspergillus flavus was identified from a nonhealing surgical wound of the ear undergoing cartilaginous necrosis in an immunocompetent host.
Objective:
We wish to alert clinicians that Aspergillus may infect surgical wounds of the ear causing significant morbidity.
Method:
A healthy man underwent Mohs micrographic surgery for invasive Bowen's disease of the ear. Due to the size and location of the defect it was allowed to heal by secondary intent. The patient developed inflammation and subsequent destruction of the ear cartilage. Aspergillus was demonstrated by touch preps and cultured from swabs and tissue from the necrotic wound.
Results:
In spite of aggressive topical and oral antifungal therapy severe distortion of the pinna occurred, resulting in surgical removal of the upper two-thirds of the ear.
Conclusions:
In the presence of cartilage necrosis following surgery on the ear, Aspergillus infection should be considered. Early aggressive management with surgical debridement, and topical and oral antifungal therapy may prevent destruction of the cartilage and a significant cosmetic defect.
Insights
Aspergillus flavus can infect ear surgical wounds, causing cartilage destruction and significant cosmetic defects. Early antifungal treatment and surgical debridement are crucial for managing this rare complication.
Area of Science:
- Dermatology
- Infectious Diseases
- Surgical Complications
Background:
- Presents an unusual complication of cutaneous surgery involving Aspergillus flavus infection in a nonhealing ear wound.
- Highlights the identification of Aspergillus flavus in a case of cartilaginous necrosis in an immunocompetent patient.
Observation:
- A healthy patient developed inflammation and cartilage destruction in an ear surgical wound after Mohs micrographic surgery for invasive Bowen's disease.
- Aspergillus was confirmed through touch preparations and cultures from the necrotic wound.
Findings:
- Despite aggressive topical and oral antifungal treatment, severe distortion of the ear (pinna) occurred.
- Surgical removal of the upper two-thirds of the ear was necessary due to the extensive damage.
Implications:
- Clinicians should consider Aspergillus infection in cases of ear cartilage necrosis post-surgery.
- Prompt surgical debridement and aggressive antifungal therapy are essential to prevent severe cosmetic deformities.