All issues > Volume 37(4); 1994

Original Article

J Korean Pediatr Soc. 1994;37(4):520-526. Published online April 15, 1994.

Primary Cutaneous Aspergillosis in Leukemic Children

Jin Young JY Park¹, Mee Ran MR Kim¹, Hee Young HY Shin¹, Hoan Jong HJ Lee¹, Hyo Seop HS Ahn¹, Je Guen JG Chi²

¹Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
²Department of Pathology, Seoul National University College of Medicine, Seoul, Korea

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.

Keywords :Aspergillus, Skin, Leukemia, Fungus, Opportunistic infection