A Case of Primary Cutaneous Aspergillus caldioustus Infection Caused by Nerve Block Therapy

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  • Sato Yukie
    Department of Dermatology, National Hospital Organization Tokyo Medical Center Meguro Tokyo, Japan.
  • Suzino Kazuyo
    Department of Dermatology, National Hospital Organization Tokyo Medical Center Meguro Tokyo, Japan.
  • Suzuki Akiko
    Department of Dermatology, National Hospital Organization Tokyo Medical Center Meguro Tokyo, Japan.
  • Fukasawa Natsuko
    Department of Dermatology, National Hospital Organization Tokyo Medical Center Meguro Tokyo, Japan.
  • Ouchi Yui
    Department of Dermatology, National Hospital Organization Tokyo Medical Center Meguro Tokyo, Japan.
  • Yaguchi Takashi
    Medical Mycology Research Center, Chiba University
  • Sato Tomotaka
    Department of Dermatology, National Hospital Organization Tokyo Medical Center Meguro Tokyo, Japan.

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Other Title
  • 神経ブロック注射部位に生じた原発性皮膚Aspergillus calidoustus感染症の１例
  • シンケイ ブロック チュウシャ ブイ ニ ショウジタ ゲンパツセイ ヒフ Aspergillus calidoustus カンセンショウ ノ 1レイ

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Abstract

We report a case of primary cutaneous Aspergillus caldioustus infection caused by nerve block therapy. A 67-year-old Japanese woman had been treated with oral predonisolon and tacrolimus for adult-onset Still disease and interstitial pneumonia. She presented with a 2-month-history of the lesions on the left back. A biopsy specimen from the skin lesion revealed granulomatous inflammation with hyphae. Culture of the pus and the skin specimen confirmed the diagnosis of cutaneous Aspergillus infection. The sequence of β- tubulin gene was analyzed to confirm the mycological diagnosis and the causative agent was identified as A. caldioustus. The patient was treated with surgical removal of the lesions and oral 200 mg/day itraconazole but she died of infectious interstitial pneumonia due to Pneumocystis jiroveci and Cytomegalovirus infection Percutaneous infection may have been responsible for the incidence of localized infection. There was no evidence of systemic aspergillosis. A. caldioustus is an emerging opportunistic fungal pathogen in immunocompromised patients. Immunocompromised patients who have persistent traumatic atypical skin lesion need to be ruled out of such rare fungus infection. An opportunistic infection in Immunocompromised patients can be life-threatening and prompt treatment based on accurate diagnosis is important.

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