Primary cutaneous aspergillosis in a preterm neonate

Abstract

Primary cutaneous aspergillosis (PCA) is a rare fungal infection in premature infants. Extreme prematurity, immature immune system, therapy with broad-spectrum antibiotics and systemic steroids, as well as hyperglycaemia and a vulnerable and very thin epidermal layer are considered risk factors in this patient population. We present a premature male infant born at 24(+3) weeks of gestation with PCA, successfully treated with amphotericin and surgical curettage of the ulcerating skin lesions. Complete resolution of the lesions was achieved and scarring was barely visible at later follow-up.

Figure 1

Erythematous, indurated papules with central, yellow crusted necrosis 7 days after initial presentation of skin lesions.

Figure 2

Progressive central ulceration on day 10.

Figure 3

H&E, ×400. Necrosis colonised by conidia and some dichotomously branching hyphae. The mycotic colonisation is mainly seen in necrotic tissue without significant inflammatory infiltration.

Figure 4

Grocott's silver stain, ×400. Necrosis colonised by conidia and some dichotomously branching hyphae.