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Primary Cutaneous Aspergillosis in Leukemic Children

Journal of the Korean Pediatric Society 1994;37(4):520-526.
Published online April 15, 1994.
Primary Cutaneous Aspergillosis in Leukemic Children
Jin Young Park1, Mee Ran Kim1, Hee Young Shin1, Hoan Jong Lee1, Hyo Seop Ahn1, Je Guen Chi2
1Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
2Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
급성 백혈병 환아에서 발병한 원발성 피부 국균증(Primary cutaneous aspergillosis)
박진영1, 김미란1, 신희영1, 이환종1, 안효섭1, 지제근2
1서울대학교 의과대학 소아과학교실
2서울대학교 의과대학 병리학교실
Abstract
Primary cutaneous aspergillosis is rare. In this report we describe primary skin infection by Aspergillus in 9 children with leukemia. The skin lesion was characterized clinically by erythematous macule and papule associated with pain and itching, followed by a rapid progression to ulcer and central black eschars with raised erythematous border at the site of venipuncture, insertion of intravenous cannula, or where arm boards had been taped to extremities. Diagnosis was confirmed by skin biopsy and wound culture. Positive culture revealed in 6 patients, including A. Glaucus in 2 cases, A. Flavus in 1 case. Treatment consisted of temporary withdrawl of anticancer chemotherapy, intravenous amphotericin B, oral flucytosine, itraconazole and /or rifampin. One patient recovered completely without antifungal medication with resolution of leukopenia. Six of eight treated patients recovered. One patient discharged against medical advice, while cutaneous aspergillosis was improving. One patient died with persistent skin lesion and neutropenia. We conclude that primary cutaneous aspergillosis is increasingly recognized in association with intravenous cannula, intravenous puncture or prolonged contact with arm boards in immunocompromised patients, and this serious disease can be treated successfully with appropriate management.
Key Words: Aspergillus, Skin, Leukemia, Fungus, Opportunistic infection


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