Soft Tissue Abscess Caused by Aspergillus Fumigatus in an Immunosuppressive Patient

Abstract

Aspergillosis is a definition including a wide variety of diseases caused by fungi in the genus Aspergillus. Aspergillosis that occurs especially in neutropenic and immunosuppressive patient is an opportunistic infection with a very high mortality rate. In this study, we presented a case of primary cutaneous aspergillosis that caused in a heart transplant recipient. Thirty-nine-years-old male patient with the complaints of high fever lasting for ten days, redness of the right thigh, swelling, and pain, was admitted to our hospital. By the tissue ultrasonography of right thigh, 3x12 cm in size of septated intensive fluid collection (abscess?) in muscle tissue at a depth of 1.5 cm to the skin surface was reported. The biopsy specimens that were taken from the lesion sent to microbiology and pathology laboratories. The branching septate hyphae were observed in Hematoxylin-Eosin and Gram stained preparations. Aspergillus fumigatus was isolated and identified from the biopsy specimen. The patient\'s symptoms were regressed rapidly and the lesion was improved by surgical debridement and antifungal agent (amphotericin B) therapy. In the light of this case report, we were emphasized that microbiologic examination and culture have an important role for diagnosis of cutaneous aspergillosis.

Keywords

• Aspergillosis, cutaneous, Aspergillus fumigatus, immunosuppressive, heart transplant

Soft Tissue Abscess Caused by Aspergillus Fumigatus in an Immunosuppressive Patient

Öz

Asperjiloz; Aspergillus genusunda yer alan mantarların meydana getirdiği çok geniş hastalıkları kapsayan bir tanımdır. Özellikle nötropenik ve immünsüpresif hastalarda gelişen aspergillozis çok yüksek mortalite oranına sahip fırsatçı bir enfeksiyondur. Bu makalede kalp nakli yapılan bir hastada meydana gelen primer kütanöz aspergillozis olgusunu sunduk. On günden uzun süren yüksek ateş, sağ uyluğunda şişlik, kızarıklık ve ağrı şikayetleri olan otuz dokuz yaşındaki erkek hasta hastanemize başvurdu. Sağ uyluk ultrasonografi incelemesinde; deri yüzeyinden 1.5 cm derinde kas dokusu içerisinde 3x12 cm boyutlarında septalı yoğun sıvı birikimi (abse?) rapor edildi. Lezyondan alınan biyopsi materyalleri mikrobiyoloji ve patoloji laboratuvarlarına gönderildi. Hematoksilen-Eozin ve Gram boyalı preparatlarda dallanmış septalı hifler görüldü. Biyopsi materyalinden Aspergillus fumigatus izole ve identifiye edildi. Cerrahi olarak debride edilen ve amfoterisin B tedavisi başlanan hastanın semptomları hızla geriledi ve lezyonları iyileşti. Bu olgu sunumunun ışığında; aspergillozisin tanısında mikrobiyolojik inceleme ve kültürün önemli bir role sahip olduğunu vurguladık

Anahtar Kelimeler

• Asperjiloz, kütanöz, Aspergillus fumigatus, immünsüpresif, kalp nakli

Kaynakça

1. Montejo M. Epidemiology of invasive fungal infection in sol- id organ transplant. Rev Iberoam Micol 2011;28(3):120-3.
2. Ramos A, Ussetti P, Laporta R, Lazaro MT, Sanchez-Romero I. Cutaneous aspergillosis in a lung transplant recipient. Transpl Infect Dis 2009;11(5):471-3.
3. Tunccan GO, Aki ASZ, Akyurek AN, Sucak SG, Esin S. Cutaneous aspergillosis in an acute lymphoblastic leu- kemia patient after allogeneic hematopoietic stem cell transplantation. Mycoses 2009;52(Suppl 1):29-123.
4. Ben-Ami R, Lewis RE, Leventakos K, Latge JP. Kontoyiannis DP. Cutaneous Model of Invasive Aspergillosis. Antimicrob Agents Chemother 2010;54(5):1848-54.
5. Galimberti, Kowalczuk, Parra H, Ramos G, Flores. Cutaneous aspergillosis: a report of six cases. British J Dermatol 1998;139(3):522-6.
6. Langlois RP, Flegel KM, Meakins JL, Morehouse DD, Robson HG, Guttmann RD. Cutaneous aspergillosis with fatal dis- semination in a renal transplant recipient. Can Med Assoc J 1980;122(6):673-6.
7. Chakrabarti A, Gupta V, Biswas G, Kumar B, Sakhuja V. Primary cutaneous aspergillosis: Our experience in 10 years. J Infect 1998;37(1):24-7.
8. Miele PS, Levy CS, Smith MA, et al. Primary cutaneous fungal infections in solid organ transplantation: a case series. Am J Transplant 2002;2(7):678-83.

9. Park SB, Kang MJ, Whang EA, Han SY, Kim HC, Park KK. A case of primary cutaneous aspergillosis in a re- nal transplant recipient. Transplantation Proceedings 2004;36(7):2156-7.
10. Thomas LM, Rand HK, Miller JL, Boyd AS. Primary cutane- ous aspergillosis in a patient with a solid organ trans- plant: Case report and review of the literature. Cutis 2008;81(2):127-30. van Burik J-AH, Colven R, Spach DH. Cutaneous
11. Aspergillosis. J Clin Microbiol 1998;36(11):3115-21.
12. Brinca A, Brites M, Figueiredo A, Serra D, Tellechea Ó. Cutaneous aspergillosis in a heart-transplant patient. Indian J Dermatol Venereol Leprol 2011;77(6):719-21.
13. Hunt SJ, Nagi C, Gross KG, Wong DS, Mathews WC. Primary Cutaneous Aspergillosis Near Central Venous Catheters in Patients With the Acquired Immunodeficiency Syndrome. Arch Dermatol 1992;128(9):1229-32.
14. Arikan S, Uzun Ö, Çetinkaya Y, Kocagöz S, Akova M, Ünal S. Primary Cutaneous Aspergillosis in Human Immunodeficiency Virus-Infected Patients: Two Cases and Review. Clin Infect Dis 1998;27(3):641-3.
15. Borbujo J, Jara M, Barros C, Amor E, Fortes D. Primary cutaneous Aspergillosis in a patient with acquired inmu- nodeficiency syndrome. J Eur Academy Dermatol Venereol 1999;12(3):268-70.
16. Murakawa GJ, Harvell JD, Lubitz P, Schnoll S, Lee S, Berger T. Cutaneous Aspergillosis and Acquired Immunodeficiency Syndrome. Arch Dermatol 2000;136(3):365-9.
17. D’Antonio D, Pagano L, Girmenia C, et al. Cutaneous Aspergillosis in Patients with Haematological Malignancies. Eur J Clin Microbiol Infect Dis 2000;19(5):362-5.
18. Yuanjie Z, Jingxia D, Hai W, Jianghan C, Julin G. Primary cutaneous aspergillosis in a patient with cutaneous T-cell lymphoma. Mycoses 2009;52(5):462-4.
19. Etienne KA, Subudhi CPK, Chadwick PR, et al. Investigation of a cluster of cutaneous aspergillosis in a neonatal inten- sive care unit. J Hosp Infect 2011;79(4):344-8.
20. Papouli M, Roilides E, Bibashi E, Andreou A. Primary cuta- neous aspergillosis in neonates: Case report and review. Clin Infect Dis 1996;22(6):1102-4.
21. Cho WH, Kim JE, Jeon DS, Kim YS, Chin HW, Shin DH. Tracheobronchial Aspergillosis following Primary Cutaneous Aspergillosis in a Lung-Transplant Recipient. Int Med 2011;50(2):131-4.