+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Cutaneous Invasive Aspergillosis: Retrospective Multicenter Study of the French Invasive-Aspergillosis Registry and Literature Review



Cutaneous Invasive Aspergillosis: Retrospective Multicenter Study of the French Invasive-Aspergillosis Registry and Literature Review



Medicine 94(26): E1018



Invasive aspergillosis (IA) has poor prognosis in immunocompromised patients. Skin manifestations, when present, should contribute to an early diagnosis. The authors aimed to provide prevalence data and a clinical and histologic description of cutaneous manifestations of primary cutaneous IA (PCIA) and secondary CIA (SCIA) in a unique clinical series of IA and present the results of an exhaustive literature review of CIA. Cases of proven and probable IA with cutaneous manifestations were retrospectively extracted from those registered between 2005 and 2010 in a prospective multicenter aspergillosis database held by the National Reference Center for Invasive Mycoses and Antifungals, Pasteur Institute, France. Patients were classified as having PCIA (i.e., CIA without extracutaneous manifestations) or SCIA (i.e., disseminated IA). Among the 1,410 patients with proven or probable IA, 15 had CIA (1.06%), 5 PCIA, and 10 SCIA. Hematological malignancies were the main underlying condition (12/15). Patients with PCIA presented infiltrated and/or suppurative lesions of various localizations not related to a catheter site (4/5), whereas SCIA was mainly characterized by disseminated papules and nodules but sometimes isolated nodules or cellulitis. Histologic data were available for 11 patients, and for 9, similar for PCIA and SCIA, showed a dense dermal polymorphic inflammatory infiltrate, with the epidermis altered in PCIA only. Periodic acid Schiff and Gomori-Grocott methenamine silver nitrate staining for all but 2 biopsies revealed hyphae compatible with Aspergillus. Aspergillus flavus was isolated in all cases of PCIA, with Aspergillus fumigatus being the most frequent species (6/10) in SCIA. Two out 5 PCIA cases were treated surgically. The 3-month survival rate was 100% and 30% for PCIA and SCIA, respectively. Our study is the largest adult series of CIA and provides complete clinical and histologic data for the disease. Primary cutaneous IA should be recognized early, and cases of extensive necrosis should be treated surgically; its prognosis markedly differs from that for SCIA. Any suppurative, necrotic, papulonodular, or infiltrated skin lesion in an immunocompromised patient should lead to immediate biopsy for histologic analysis and mycological skin direct examination and culture.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 057547522

Download citation: RISBibTeXText

PMID: 26131805

DOI: 10.1097/md.0000000000001018


Related references

Primary cutaneous aspergillosis complicated with invasive aspergillosis in an extremely preterm infant: case report and literature review. Archives de Pediatrie 17(10): 1455-1459, 2010

Invasive pulmonary aspergillosis in a critically ill neonate: case report and review of invasive aspergillosis during the first 3 months of life. Clinical Infectious Diseases 27(3): 437-452, 1998

Invasive Pulmonary Aspergillosis in the Epidural Space in a Patient with Acute Myelogenous Leukemia with Myelodysplasia-related Changes: A Case Study and Literature Review of Vertebral Aspergillosis in Japan. Internal Medicine 57(21): 3205-3212, 2018

Invasive pulmonary aspergillosis in patients with influenza infection: A retrospective study and review of the literature. Clinical Respiratory Journal 13(4): 202-211, 2019

Simultaneous primary invasive cutaneous aspergillosis in two preterm twins: case report and review of the literature. Bmc Infectious Diseases 17(1): 535, 2017

Clinical applicability of the new EORTC/MSG classification for invasive pulmonary aspergillosis in patients with hematological malignancies and autopsy-confirmed invasive aspergillosis. Annals of Hematology 82(2): 80-82, 2003

Pediatric invasive aspergillosis: a multicenter retrospective analysis of 139 contemporary cases. Pediatrics 121(5): E1286-E1294, 2008

Allogeneic Hematopoietic Stem Cell Transplantation in Patients with a History of Prior Invasive Aspergillosis Outcomes and Risks for Post-Transplant Invasive Aspergillosis. Blood 100(11): Abstract No 2463, 2002

Invasive aspergillosis caused by Aspergillus terreus Multicenter retrospective analysis of 87 cases. Abstracts of the Interscience Conference on Antimicrobial Agents & Chemotherapy 43: 475, 2003

Invasive pulmonary aspergillosis secondary to microwave ablation: a multicenter retrospective study. International Journal of Hyperthermia 35(1): 71-78, 2018

Voriconazole Resistance and Mortality in Invasive Aspergillosis: A Multicenter Retrospective Cohort Study. Clinical Infectious Diseases 68(9): 1463-1471, 2019

Acute Invasive Pulmonary Aspergillosis Complicating Allergic Bronchopulmonary Aspergillosis: Case Report and Systematic Review. Mycopathologia 180(3-4): 209-215, 2015

Diagnosing Invasive Pulmonary Aspergillosis in Hematology Patients: a Retrospective Multicenter Evaluation of a Novel Lateral Flow Device. Journal of Clinical Microbiology 57(4):, 2019

Invasive aspergillosis and surgery. Literature review. Journal de Mycologie Medicale 9(2): 97-102, 1999

Invasive pulmonary aspergillosis: retrospective case record review. Revista Iberoamericana de Micologia 21(1): 35-38, 2004