title: Cutaneous invasive aspergillosis in a patient with glioblastoma receiving long-term temozolomide and corticosteroid therapy.
abstract: Glioblastoma is an aggressive brain tumor that requires multidisciplinary treatment including adjuvant radiotherapy, chemotherapy, and adjunct corticosteroids. Temozolomide is a commonly used chemotherapy drug and frequently causes lymphocytopenia. We describe the case of a 67-year-old woman with cutaneous invasive aspergillosis who had received long-term temozolomide and corticosteroid therapy for glioblastoma. She presented with multiple indurations, erythema, and purpura, some of which produced purulent discharge, in the anterior abdomen. Extensive intra- or inter-muscular abscesses of the right anterior abdominal wall were also observed. Her absolute lymphocyte counts were 156/μL on admission. Cultures obtained from the wound yielded Aspergillus fumigatus. She was diagnosed with secondary cutaneous invasive aspergillosis, which likely resulted from hematogenous dissemination. Although rare, this case illustrates that temozolomide-induced lymphocytopenia, especially in cases of concomitant corticosteroid use, can be associated with severe invasive aspergillosis.
authors.affiliation: Division of Hematology, Jichi Medical University Hospital, Tochigi, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Ikeda
authors.affiliation: Division of Infectious Diseases, Jichi Medical University Hospital, Tochigi, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Suzuki
authors.affiliation: Division of Infectious Diseases, Jichi Medical University Hospital, Tochigi, Japan.
authors.forename: Masataro
authors.initials: M
authors.lastname: Norizuki
authors.affiliation: Division of Infectious Diseases, Jichi Medical University Hospital, Tochigi, Japan.
authors.forename: Taro
authors.initials: T
authors.lastname: Okabe
authors.affiliation: Division of Infectious Diseases, Jichi Medical University Hospital, Tochigi, Japan.
authors.forename: Tsubasa
authors.initials: T
authors.lastname: Onishi
authors.affiliation: Division of Infectious Diseases, Jichi Medical University Hospital, Tochigi, Japan.
authors.forename: Teppei
authors.initials: T
authors.lastname: Sasahara
authors.affiliation: Division of Hematology, Jichi Medical University Hospital, Tochigi, Japan; Division of Infectious Diseases, Jichi Medical University Hospital, Tochigi, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Toshima
authors.affiliation: Division of Neurosurgery, Jichi Medical University Hospital, Tochigi, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Yokota
authors.affiliation: Division of Infectious Diseases, Jichi Medical University Hospital, Tochigi, Japan; Division of General Internal Medicine, Jichi Medical University Hospital, Tochigi, Japan. Electronic address: shatake-tky@umin.ac.jp.
authors.forename: Shuji
authors.initials: S
authors.lastname: Hatakeyama
authors.affiliation: Division of Infectious Diseases, Jichi Medical University Hospital, Tochigi, Japan; Division of General Internal Medicine, Jichi Medical University Hospital, Tochigi, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Morisawa
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects*; D000368:Aged; D001228:Aspergillosis / Q000139:chemically induced*; D001932:Brain Neoplasms / Q000188:drug therapy; D003131:Combined Modality Therapy / Q000379:methods; D003606:Dacarbazine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D005260:Female; D005909:Glioblastoma / Q000188:drug therapy*; D006801:Humans; D012867:Skin / Q000382:microbiology*; D000077204:Temozolomide
chemical_list: D000305:Adrenal Cortex Hormones; D003606:Dacarbazine; D000077204:Temozolomide
keywords: Corticosteroids; Cutaneous invasive aspergillosis; Glioblastoma; Temozolomide