title: [Case of primary cutaneous Aspergillus caldioustus infection caused by nerve block therapy].
abstract: We report a case of primary cutaneous Aspergillus caldioustus infection caused by nerve block therapy. A 67-year-old Japanese woman had been treated with oral predonisolon and tacrolimus for adult-onset Still disease and interstitial pneumonia. She presented with a 2-month-history of the lesions on the left back. A biopsy specimen from the skin lesion revealed granulomatous inflammation with hyphae. Culture of the pus and the skin specimen confirmed the diagnosis of cutaneous Aspergillus infection. The sequence of β- tubulin gene was analyzed to confirm the mycological diagnosis and the causative agent was identified as A. caldioustus. The patient was treated with surgical removal of the lesions and oral 200 mg/day itraconazole but she died of infectious interstitial pneumonia due to Pneumocystis jiroveci and Cytomegalovirus infection Percutaneous infection may have been responsible for the incidence of localized infection. There was no evidence of systemic aspergillosis. A. caldioustus is an emerging opportunistic fungal pathogen in immunocompromised patients. Immunocompromised patients who have persistent traumatic atypical skin lesion need to be ruled out of such rare fungus infection. An opportunistic infection in Immunocompromised patients can be life-threatening and prompt treatment based on accurate diagnosis is important.
authors: Department of Dermatology, National Hospital Organization Tokyo Medical Center Meguro Tokyo, Japan.
authors: Yukie
authors: Y
authors: Sato
authors: Kazuyo
authors: K
authors: Suzino
authors: Akiko
authors: A
authors: Suzuki
authors: Natsuko
authors: N
authors: Fukasawa
authors: Yui
authors: Y
authors: Ouchi
authors: Takashi
authors: T
authors: Yaguchi
authors: Tomotaka
authors: T
authors: Sato
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000008:administration & dosage; D001228:Aspergillosis / Q000150:complications* / Q000382:microbiology* / Q000628:therapy; D001230:Aspergillus / Q000235:genetics / Q000302:isolation & purification*; D003881:Dermatomycoses / Q000150:complications* / Q000382:microbiology* / Q000628:therapy; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D017964:Itraconazole / Q000008:administration & dosage; D009407:Nerve Block / Q000009:adverse effects*; D009894:Opportunistic Infections / Q000150:complications* / Q000382:microbiology* / Q000628:therapy; D014404:Tubulin / Q000235:genetics
chemical_list: D000935:Antifungal Agents; D014404:Tubulin; D017964:Itraconazole