title: Coexistence of fatal disseminated invasive aspergillosis and pyoderma gangrenosum: a case report.
abstract: OBJECTIVE
  To report an unusual case of disseminated aspergillosis involving the lymph nodes, lungs, and skin in a patient with pyoderma gangrenosum (PG) and myelodysplastic syndrome (MDS).
  
  
  METHODS
  A 46-year-old man presented with productive cough of 2 weeks' duration. Besides, several painless, fixed lymph nodes were palpated at his left neck. He had PG and MDS diagnosed in June 2004 with regular use of oral dapsone and prednisolone. His skin lesions healed with scar formation and no purulent discharge. A computed tomography scan of the head, neck and chest showed bilateral lung consolidation and abscesses at the left neck, right upper lung and right pleura. The neck abscess culture grew Aspergillus species. Dark reddish macules developed over the right arm, chest and abdominal wall, and the left lower limb 2 weeks after initiation of amphotericin B. The histology of the right arm skin biopsy showed invasive aspergillosis. Caspofungin was started then for suspicion of poor response to amphotericin B. He expired despite 35 days of antifungal therapy.
  
  
  CONCLUSIONS
  This report highlights the rarity of coexistence of disseminated aspergillosis and PG, and should alert physicians to the possibility of invasive fungal infection superimposed on a chronic skin lesion.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Chien-Chang
authors.initials: CC
authors.lastname: Yang
authors.forename: Po-Chang
authors.initials: PC
authors.lastname: Hsu
authors.forename: Chun-Wen
authors.initials: CW
authors.lastname: Cheng
authors.forename: Ming-Hsun
authors.initials: MH
authors.lastname: Lee
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D000077336:Caspofungin; D054714:Echinocandins / Q000627:therapeutic use; D017809:Fatal Outcome; D006801:Humans; D055666:Lipopeptides; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology / Q000473:pathology; D017511:Pyoderma Gangrenosum / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology
chemical_list: D000305:Adrenal Cortex Hormones; D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000077336:Caspofungin