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Review
. 2017 Aug 2;17(1):535.
doi: 10.1186/s12879-017-2646-8.

Simultaneous primary invasive cutaneous aspergillosis in two preterm twins: case report and review of the literature

Floriane Gallais  1 , Julie Denis  2   3 , Olfa Koobar  4 , Laurence Dillenseger  4 , Dominique Astruc  4 , Raoul Herbrecht  5 , Ermanno Candolfi  2   3 , Valérie Letscher-Bru  2   3 , Marcela Sabou  2   3
Affiliations
Review

Simultaneous primary invasive cutaneous aspergillosis in two preterm twins: case report and review of the literature

Floriane Gallais et al. BMC Infect Dis. .

Abstract

Background: Primary invasive cutaneous aspergillosis is a rare fungal infection that occurs mostly in immunocompromised patients. Newborns of very low birth weight present a high risk for this type of infection due to an immaturity of the cutaneous barrier and of the immune system.

Case presentation: We describe here a case of simultaneous invasive cutaneous aspergillosis in two preterm twins. Two male preterm bichorionic biamniotic twins (A & B) were born at a general hospital by spontaneous normal delivery at 24 weeks and 6 days of gestation. They were transferred to our hospital where they receive surfactant, antibiotics and hydrocortisone. Six days later, twin A showed greenish lesions in the umbilical region. The spectrum of antibiotic therapy was broadened and fluconazole was added. The umbilical catheters of the two twins were removed and replaced by epicutaneo-cava venous catheters and the cultures were positive for Aspergillus fumigatus. Fluconazole was replaced in both twins by liposomal amphotericin B and the incubators were changed. The serum galactomannan was also positive for both twins. At day 10, yellowish lesions appeared in the abdominal region in twin B. He died on day 18 following complications related to his prematurity. Concerning the twin A, serum galactomannan was negative on day 30; liposomal amphotericin B was stopped 1 week later, with a relay by econazole (cream). His condition improved and on day 66 he was transferred for follow-up at the general hospital where he was born.

Conclusion: The source of contamination by A. fumigatus was not identified, but other similar cases from the literature include construction work at or near the hospital, oximeter sensors, latex finger stalls, non-sterile gloves, humidifying chambers of incubators, bedding and adhesive tapes. The skin fragility of preterm newborns is an excellent potential entry point for environmental fungal infections. These cases highlight the importance of suspecting primary cutaneous aspergillosis in extremely low birth weight neonates with rapidly progressive necrotic lesions.

Keywords: A. fumigatus; Aspergillus; Invasive aspergillosis; Newborn; Premature; Preterm; Primary cutaneous aspergillosis.

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Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

Written informed consent was obtained from the parents of the patients for publication of this case report and any accompanying images.

Competing interests

The authors declare that they have no competing interests.

Competing interests

The Authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Abdominal lesions of twin A (Day 10)
Fig. 2
Fig. 2
Abdominal lesions of twin B (Day 17)
Fig. 3
Fig. 3
Timeline
See this image and copyright information in PMC

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