gms | German Medical Science

Introduction: By the rise of the number of immunosuppressed patients, the prevalence of aspergillus infection has increased. It is still one of the most causes of death in solid organ transplant clinics and hematology units. We report pulmoner and cutaneous aspergillosis case which is rarely seen, developed after diagnosis of aplastic anemia.

Clinical Case: A sixty year old male patient with bleeding gums, weakness was admitted to hospital he has applied before with hemogram results. Clinicians diagnosed aplastic anemia after performing a bone marrow biopsy. Then cyclosporin treatment was started.

Anti-thymocyte globulin (ATG), cyclosporin and steroid therapy has started when the pancytopenia recognised at hemogram of the patient applied for control to our hospital’s hematology clinic. During the first month of immunosuppressive therapy, on the front right tibia and back of the left tibia an erythema nodosum, furuncle like lesions raised from the skin were recognised (Figure 1 [Fig. 1]). They reddened, were painful by palpitation, had darker central part and 3-7 cm diameter. Skin biopsies were performed from these lesions.

Pathologic examination result was lobular panniculitis and demonstrate abundant aspergillus spor and hyphae. The patient was treated with liposomal amphotericin B dosing 5mg/kg. Because of the skin lesions are mycotic septic emboli, for the sake of endocarditis echocardiography performed and pathology could not found. At high resolution computer tomography (HRCT), lesions similar to fungal involvement were determined. The lesion on the front right tibia was more organised so surgical decompression required. After 21 day liposomal amphotericin B treatment, new lesions were appeared on the skin. The patient received voriconazole 6 mg/kg IV loading dose then followed by 4mg/kg dose. Skin lesions and pulmoner involement reduced (Figure 2 [Fig. 2]).

Discussion: It is important that life threatening fungal infections like aspergillus in immunosuppressive patient groups, clinical progression should observed; susceptibility testing of strains isolated be performed and be aware of non-pulmoner involvement.