Secondary cutaneous aspergillosis due to Aspergillus flavus in an acute myeloid leukaemia patient following stem cell transplantation.
In a 64-year-old man suffering from hypoblastic myelodysplastic syndrome a secondary acute myeloid leukaemia developed. After induction chemotherapy with resulting partial remission he received an allogenic (related) peripheral blood stem cell transplantation conditioned with 2 Gy total body irradiation. After haematopoietic reconstitution chest pain and dyspnoea appeared. Computer tomography revealed diffuse bilateral infiltrates which were considered to be suspicious for an invasive pulmonary aspergillosis of the left upper lobe. Respiratory and circulatory insufficiency occurred. In bronchoalveolar lavage fluid Aspergillus antigen was detected. In addition, Aspergillus flavus was isolated on Sabouraud-dextrose agar. Ambisome (liposomal encapsulated amphotericin B) was applied in high dosages. On the skin of the sides and the back five livid red stained nodular lesions with haemorrhagic infarctions appeared. Pathohistologically, both in PAS (periodate acid Schiff) and Grocott-Gomori staining conglomerates of septated hyphae were detected in corium and subcutis. In addition, Aspergillus flavus grew from skin tissue. Despite antifungal treatment the patient died from Aspergillus pneumonia and generalized aspergillosis with dissemination to heart, brain, and skin.
Nenoff
Pietro
P
Department of Dermatology, University of Leipzig, Stephanstrasse 11, D-04103 Leipzig, Germany. nenp@server3.medizin.uni-liepzig.de
Kliem
Constanze
C
Mittag
Matthias
M
Horn
Lars-Christian
LC
Niederwieser
Dietger
D
Haustein
Uwe-Frithjof
UF
D000208:Acute Disease; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000150:complications* / Q000188:drug therapy; D001231:Aspergillus flavus / Q000302:isolation & purification*; D003881:Dermatomycoses / Q000188:drug therapy / Q000209:etiology*; D017809:Fatal Outcome; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007951:Leukemia, Myeloid / Q000150:complications / Q000628:therapy*; D008172:Lung Diseases, Fungal / Q000150:complications* / Q000188:drug therapy; D008297:Male
D000935:Antifungal Agents; D000666:Amphotericin B