JOURNAL CLUP, IDDr. Naif S Saglan ,, F1

CASE DISCUSSION :• 21 years , female , dx in 2008 as ALL .

• Dx and Tx in KAMC + UK and complete her chemo therapy 2010.

• Patient got marred 2015 , and during her antenatal care her obstetrician notice her CBC was not normal .

• Admitted again to KAMC and Dx as relapsed with different type of leukemia as AML.

• She received chemo therapy 3 cycle . ( 25/06/2015 to 2/07/2015 ).

Cont. • Her chemo postponed after delivery .

• During her chemo therapy course patient developed a skin lesion on her RT arm , on the extensor surface , round in shape , red walls with pus and discharge and foul smiling associated with itching and high grade fever (38C -39C), no other lesions .

• Last cycle was (21-24 /08/2015) .

Cont. .• Fever 38, intermittent pattern relived by anti pyritic associated with rigor and chills , bone pain , palpitations.

• No rashes .• No cough or expectoration.• No meningeal signs or abnormal movements .• No change of her level of conscious .

Past Medical Hx : Cardiac myopathy . Skin lesion in her genitalia (2008).

Cont. . Travelling Hx : UK for therapy

Drug Hx : chemotherapy , No steroids

Blood transfusion Hx : Several times .

Systemic review : Un Remarkable

Cont. .

Patient well , conscious, oriented , setting on the bed .• Vitals : Afebrile , blood pressure: 119/73 • ENT : No thrush No lymphadenopathy • Chest : Vesicle Breathing Bilaterally , Crackles on the bases

Cont. .• CVS : S1+S2 , No murmurs .

• Abdomen : Soft , Sax , No Organomegaly CNS : Grossly Intact

• Musculoskeletal : Un Remarkable apart of her Rt arm lesion .

Differential dx :

•1- Cellulitis•2- Ecythma•3- Ecyrhma gangrenosum •4- ,,,,,,,,,,,,,,,,,,,,,,,

Investigations : CBC :

Thrombocytopenia LeukopeniaKIDNEY AND LIVER PROFILE :

Normal Limit IMAGES : No Focus Cultures :

Blood Sputum ALL NO GROWTH Urine

Skin biopsy :

DIAGNOSIS : Aspergillus Fumigatus

Treatment :

Voriconazole (6 mg/kg IV every 12 h for 1 day, followed by 4 mg/kg IV every 12 h )

Dermatologic Manifestations of Aspergillosis :

Cutaneous aspergillosis is usually a cutaneous manifestation of disseminated infection with the fungus Aspergillus.

Primary cutaneous disease is rare and is most commonly caused by Aspergillus fumigatus and Aspergillus flavus.

Skin lesions occur in 5-10% of patients with disseminated aspergillosis

Cont. .The most typical presentation is implantation of the fungus following trauma, including infections at the site of intravenous cannulas, or venipuncture wounds.

A fumigatus is the most common pathogen associated with disseminated disease with cutaneous involvement.

A flavus or A terreus most often causes the less frequent primary infections of the skin. Aspergillus niger and Aspergillus ustus have also been cultured from cutaneous lesions .

Cont. .

Invasive aspergillosis affects people who have weakened immune systems, such as people who have had a stem cell transplant or organ transplant, are getting chemotherapy for cancer, or are taking high doses of corticosteroids.

Cutaneous presentations of systemic aspergillosis most frequently begin as solitary or multiple erythematous or violaceous indurated papules or plaques . lesions are often tender, but can be asymptomatic .

Cont. . In both disseminated and limited cutaneous aspergillosis, high-dose intravenous amphotericin B, in traditional or liposomal form.

Voriconazole is also approved as a first-line agent for aspergillosis.

Treatment options for aspergillosis include itraconazole .

Reference IDSA

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