Cutaneous, pulmonary and sinusal aspergillosis in a diabetic patient

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Published Jun 23, 2010
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Vol. 88 No. 7 (2010): Issue Jul 2010

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Aida Khaled
Becima Fazaa
Hôpital Charles Nicolle de Tunis
Donia Ammar
Alya Bouzgarrou
Samir Boubaker
Mohamed Ridha Kamoun

Abstract

Background : Cutaneous aspergillosis is rarely reported in diabetic patients.
Aim : The objective of our study is to report a case of lethal disseminated aspergillosis revealed by multiples skin necroses, with pulmonary and sinusal involvement in a diabetic patient.
Case report: A 60-year-old diabetic woman, presented with one month -rapidly –extensive, 1 to 10 cm skin necroses of the trunk, limbs and eyelids. Few days after her admission, she developed dyspnoea. Chest X-ray showed an interstitial and alveolar syndrome with multiple excavated anfractuous-edged-opacities. Facial CT scan showed a right orbital cellulitis with Pansinusitis. The methaminesilver stains on a cutaneous biopsy showed filamentous septate fungal hyphae with branches at right angles. The immunofluorescence with an anti-aspergillus serum was positive. The diagnosis of secondary disseminated aspergillosis to a primary pulmonary focus with cutaneous, sinusal, and upper airway’s dissemination was made. The patient died despite an intravenous amphotericin B therapy.
Conclusion : This report emphasizes the importance of evoking and seeking for a mycosis in every skin necrotic and ulcerative lesions occurring in an immunocompromised patient. The prognosis depends on the diagnosis and treatment institution delay.

Keywords:

Cutaneous aspergillosis, diabetes

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