title: A novel type of metastatically spreading subcutaneous aspergillosis without epidermal lesions following allogeneic stem cell transplantation.
abstract: Systemic mycosis is among the most feared opportunistic infections in the immunocompromised host. Difficulty and delay in diagnosis and treatment often result in poor outcomes. In this communication a metastatically spreading form of subcutaneous aspergillosis developed in a patient with a history of allogeneic stem cell transplantation for relapsed Hodgkin's lymphoma. Strikingly, necrotizing cutaneous papules or ulcerating lesions were absent. Diagnosis was accomplished after excision of a clinically non-suggestive subcutaneous nodule. Despite prompt initiation of antimycotic therapy the outcome was fatal; dosage of conventional and liposomal amphotericin B was limited due to treatment-related toxicities. This case report describes a novel form of aspergillosis and underlines the need for an aggressive diagnostic approach in severely immunocompromised patients.
authors.affiliation: Department I of Internal Medicine, Hematology, Oncology and Infectious Diseases, University of Cologne, Cologne, Germany.
authors.forename: O A
authors.initials: OA
authors.lastname: Cornely
authors.forename: H
authors.initials: H
authors.lastname: Pels
authors.forename: U
authors.initials: U
authors.lastname: Bethe
authors.forename: M
authors.initials: M
authors.lastname: Seibold
authors.forename: K
authors.initials: K
authors.lastname: Toepelt
authors.forename: D
authors.initials: D
authors.lastname: Soehngen
authors.forename: A
authors.initials: A
authors.lastname: Ritzkowsky
mesh_terms: D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D001228:Aspergillosis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000473:pathology*; D001761:Bleomycin / Q000008:administration & dosage; D002330:Carmustine / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D003606:Dacarbazine / Q000008:administration & dosage; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D003907:Dexamethasone / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D017809:Fatal Outcome; D018380:Hematopoietic Stem Cell Transplantation; D006689:Hodgkin Disease / Q000150:complications* / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy; D006801:Humans; D016867:Immunocompromised Host; D007710:Klebsiella Infections / Q000150:complications / Q000188:drug therapy; D007711:Klebsiella pneumoniae / Q000302:isolation & purification; D008172:Lung Diseases, Fungal / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D009364:Neoplasm Recurrence, Local; D009894:Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000473:pathology*; D018410:Pneumonia, Bacterial / Q000150:complications / Q000188:drug therapy; D011020:Pneumonia, Pneumocystis / Q000150:complications / Q000188:drug therapy; D011241:Prednisone / Q000008:administration & dosage; D011344:Procarbazine / Q000008:administration & dosage; D016879:Salvage Therapy; D012867:Skin; D014184:Transplantation, Homologous; D014747:Vinblastine / Q000008:administration & dosage; D014750:Vincristine / Q000008:administration & dosage; D000093542:Gemcitabine
chemical_list: D000935:Antifungal Agents; D003561:Cytarabine; D003841:Deoxycytidine; D001761:Bleomycin; D011344:Procarbazine; D014750:Vincristine; D014747:Vinblastine; D005047:Etoposide; D003606:Dacarbazine; D003907:Dexamethasone; D000666:Amphotericin B; D004317:Doxorubicin; D003520:Cyclophosphamide; D008558:Melphalan; D002330:Carmustine; D011241:Prednisone; D000093542:Gemcitabine