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Unilateral Cutaneous Emboli of Aspergillus

Unilateral Cutaneous Emboli of Aspergillus Abstract • A 40-year-old white woman with acute nonlymphocytic leukemia, which relapsed despite bone marrow transplantation and various chemotherapeutic regimens, developed fever and neutropenia. Her fever was unresponsive to broad-spectrum antibiotics, and on hospital day 53 she developed purpuric macules with necrotic centers on her left hand and forearm. Frozen sections of lesional skin were stained with Grocott's methenamine-silver and showed hyphae consistent with a species of Aspergillus; culture of the skin biopsy specimen yielded a pure culture of Aspergillus flavus. Localization of the emboli to the left upper extremity was subsequently explained by magnetic resonance imaging scan of the chest demonstrating invasion of the left subclavian artery by a pulmonary aspergilloma. (Arch Dermatol. 1990;126:1214-1217) References 1. Bardana EJ. The clinical spectrum of aspergillosis, I: epidemiology, pathogenicity, infection in animals and immunology of Aspergillus Crit Rev Clin Lab Sci. 1980;13:21-83.Crossref 2. Bardana EJ. The clinical spectrum of aspergillosis, II:classification and description of saprophytic, allergic, and invasive variants of human disease . Crit Rev Clin Lab Sci. 1980;13:85-159Crossref 3. Rippon JW. Medical Mycology: The Pathogenic Fungi and the Pathogenic Actinomycetes . 3rd ed. Philadelphia, Pa: WB Saunders Co; 1988. 4. Young RC, Bennett JE, Vogel CI, Carbone PP, DeVita VT. Aspergillosis: the spectrum of disease in 98 patients . Medicine . 1970;49:147-173.Crossref 5. Rinaldi MG. Invasive aspergillosis . Rev Infect Dis. 1983;5: 1061-1077.Crossref 6. Gerson SL, Talbot GH, Hurwitz S, et al. Prolonged granulocytopenia: the major risk factor for invasive pulmonary aspergillosis in patients with acute leukemia . Ann Intern Med. 1984;100:345-351.Crossref 7. Meyer RD, Young LS, Armstrong D, Yu B. Aspergillosis complicating neoplastic disease . Am J Med. 1973;54:6-15.Crossref 8. Tan KK, Kenji S, Tan KL. Disseminated aspergillosis: case report and review of the world literature . Am J Clin Pathol. 1966; 45:697-703. 9. Grossman ME, Fithian EC, Behrens C, et al. Primary cutaneous aspergillosis in six leukemic children . J Am Acad Dermatol. 1985;12:313-318.Crossref 10. Barson WJ Ruymann FB. Palmar aspergillosis in immunocompromised children . Pediatr Infect Dis. 1986;5:264-268.Crossref 11. McCarty JM, Flam MS, Pullen G, Jones R, Kassel SH. Outbreak of primary cutaneous aspergillosis related to intravenous arm boards . J Pediatr. 1986;108(pt (1) ):721-724.Crossref 12. Allo MD, Miller J, Townsend T, Tan C. Primary cutaneous aspergillosis associated with Hickman intravenous catheters . N Engl J Med. 1987;317:1105-1108.Crossref 13. Prystowsky SD, Vogelstein B, Ettinger D, et al. Invasive aspergillosis . N Engl J Med. 1976;295:655-658.Crossref 14. Khardori N, Hayat S, Rolston K, Bodey GP. Cutaneous Rhizopus and Aspergillus infections in five patients with cancer . Arch Dermatol. 1989;125:952-956.Crossref 15. Weingarten JS, Crockett DM, Lusk RP. Fulminant aspergillosis: early cutaneous manifestations and the disease process in the immunocompromised host . Otolaryngol Head Neck Surg. 1987;97:495-499. 16. Dreizen S, Bodey GP, McCredie KB, Keating MJ. Orofacial aspergillosis in acute leukemia . Oral Surg Oral Med Oral Pathol. 1985;59:499-504.Crossref 17. Findlay GH, Roux HF, Simson IW. Skin manifestations in disseminated aspergillosis . Br J Dermatol. 1971;85:( (suppl 7) ):94-97.Crossref 18. Rafferty P, Biggs B-A, Crompton GK, Grant IWB. What happens to patients with pulmonary aspergilloma? analysis of 23 cases . Thorax. 1983;38:579-583.Crossref 19. Weitzman I. Saprophytic molds as agents of cutaneous and subcutaneous infection in the immunocompromised host . Arch Dermatol. 1986;122:1161-1168.Crossref 20. Vedder JS, Schorr WF. Primary disseminated pulmonary aspergillosis with metastatic skin nodules: successful treatment with inhalation nystatin therapy . JAMA. 1969;209:1191-1195.Crossref 21. Cahill KM, El Mofty AM, Kawaguchi P. Primary cutaneous aspergillosis . Arch Dermatol. 1967;96:545-547.Crossref 22. Allan GW, Andersen DH. Generalized aspergillosis in an infant 18 days of age . Pediatrics. 1960;26:432-440. 23. Radentz WH. Opportunistic fungal infections in immunipromised hosts . J Am Acad Dermatol. 1989;20:989-1003.Crossref 24. Lever WF, Schaumberg-Lever G. Histopathology of the Skin . 6th ed. Philadelphia, Pa: JB Lippincott; 1983. 25. Cawley EP. Aspergillosis and the aspergilli: report of a unique case of the disease . Arch Intern Med. 1947;80:423-434.Crossref 26. Gerstl B, Weidman WH, Newmann AV. Pulmonary aspergillosis: report of two cases . Ann Intern Med. 1948;28:662-671.Crossref 27. Myrowitz RL, Friedman R, Grossman WI. Mycotic 'mycotic aneurysm' of the aorta due to Aspergillus fumigatus . Am J Clin Pathol. 1971;55:241-246. 28. Vo NM, Russell JC, Becker DR. Mycotic embolic of the peripheral vessels: analysis of forty-four cases . Surgery. 1981; 90: 541-545. 29. Feldman C, Mason P, Russell Jones R, Kelley C. Femoral mycotic aneurysm presenting as arthritis and purpura . Br J Rheumatol. 1985;24:364-366.Crossref 30. Merry M, Dunn J, Weismann R, Harris ED. Popliteal mycotic aneurysm presenting as septic arthritis and purpura . JAMA. 1972;221:58-59.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Unilateral Cutaneous Emboli of Aspergillus

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Publisher
American Medical Association
Copyright
Copyright © 1990 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1990.01670330094015
Publisher site
See Article on Publisher Site

Abstract

Abstract • A 40-year-old white woman with acute nonlymphocytic leukemia, which relapsed despite bone marrow transplantation and various chemotherapeutic regimens, developed fever and neutropenia. Her fever was unresponsive to broad-spectrum antibiotics, and on hospital day 53 she developed purpuric macules with necrotic centers on her left hand and forearm. Frozen sections of lesional skin were stained with Grocott's methenamine-silver and showed hyphae consistent with a species of Aspergillus; culture of the skin biopsy specimen yielded a pure culture of Aspergillus flavus. Localization of the emboli to the left upper extremity was subsequently explained by magnetic resonance imaging scan of the chest demonstrating invasion of the left subclavian artery by a pulmonary aspergilloma. (Arch Dermatol. 1990;126:1214-1217) References 1. Bardana EJ. The clinical spectrum of aspergillosis, I: epidemiology, pathogenicity, infection in animals and immunology of Aspergillus Crit Rev Clin Lab Sci. 1980;13:21-83.Crossref 2. Bardana EJ. The clinical spectrum of aspergillosis, II:classification and description of saprophytic, allergic, and invasive variants of human disease . Crit Rev Clin Lab Sci. 1980;13:85-159Crossref 3. Rippon JW. Medical Mycology: The Pathogenic Fungi and the Pathogenic Actinomycetes . 3rd ed. Philadelphia, Pa: WB Saunders Co; 1988. 4. Young RC, Bennett JE, Vogel CI, Carbone PP, DeVita VT. Aspergillosis: the spectrum of disease in 98 patients . Medicine . 1970;49:147-173.Crossref 5. Rinaldi MG. Invasive aspergillosis . Rev Infect Dis. 1983;5: 1061-1077.Crossref 6. Gerson SL, Talbot GH, Hurwitz S, et al. Prolonged granulocytopenia: the major risk factor for invasive pulmonary aspergillosis in patients with acute leukemia . Ann Intern Med. 1984;100:345-351.Crossref 7. Meyer RD, Young LS, Armstrong D, Yu B. Aspergillosis complicating neoplastic disease . Am J Med. 1973;54:6-15.Crossref 8. Tan KK, Kenji S, Tan KL. Disseminated aspergillosis: case report and review of the world literature . Am J Clin Pathol. 1966; 45:697-703. 9. Grossman ME, Fithian EC, Behrens C, et al. Primary cutaneous aspergillosis in six leukemic children . J Am Acad Dermatol. 1985;12:313-318.Crossref 10. Barson WJ Ruymann FB. Palmar aspergillosis in immunocompromised children . Pediatr Infect Dis. 1986;5:264-268.Crossref 11. McCarty JM, Flam MS, Pullen G, Jones R, Kassel SH. Outbreak of primary cutaneous aspergillosis related to intravenous arm boards . J Pediatr. 1986;108(pt (1) ):721-724.Crossref 12. Allo MD, Miller J, Townsend T, Tan C. Primary cutaneous aspergillosis associated with Hickman intravenous catheters . N Engl J Med. 1987;317:1105-1108.Crossref 13. Prystowsky SD, Vogelstein B, Ettinger D, et al. Invasive aspergillosis . N Engl J Med. 1976;295:655-658.Crossref 14. Khardori N, Hayat S, Rolston K, Bodey GP. Cutaneous Rhizopus and Aspergillus infections in five patients with cancer . Arch Dermatol. 1989;125:952-956.Crossref 15. Weingarten JS, Crockett DM, Lusk RP. Fulminant aspergillosis: early cutaneous manifestations and the disease process in the immunocompromised host . Otolaryngol Head Neck Surg. 1987;97:495-499. 16. Dreizen S, Bodey GP, McCredie KB, Keating MJ. Orofacial aspergillosis in acute leukemia . Oral Surg Oral Med Oral Pathol. 1985;59:499-504.Crossref 17. Findlay GH, Roux HF, Simson IW. Skin manifestations in disseminated aspergillosis . Br J Dermatol. 1971;85:( (suppl 7) ):94-97.Crossref 18. Rafferty P, Biggs B-A, Crompton GK, Grant IWB. What happens to patients with pulmonary aspergilloma? analysis of 23 cases . Thorax. 1983;38:579-583.Crossref 19. Weitzman I. Saprophytic molds as agents of cutaneous and subcutaneous infection in the immunocompromised host . Arch Dermatol. 1986;122:1161-1168.Crossref 20. Vedder JS, Schorr WF. Primary disseminated pulmonary aspergillosis with metastatic skin nodules: successful treatment with inhalation nystatin therapy . JAMA. 1969;209:1191-1195.Crossref 21. Cahill KM, El Mofty AM, Kawaguchi P. Primary cutaneous aspergillosis . Arch Dermatol. 1967;96:545-547.Crossref 22. Allan GW, Andersen DH. Generalized aspergillosis in an infant 18 days of age . Pediatrics. 1960;26:432-440. 23. Radentz WH. Opportunistic fungal infections in immunipromised hosts . J Am Acad Dermatol. 1989;20:989-1003.Crossref 24. Lever WF, Schaumberg-Lever G. Histopathology of the Skin . 6th ed. Philadelphia, Pa: JB Lippincott; 1983. 25. Cawley EP. Aspergillosis and the aspergilli: report of a unique case of the disease . Arch Intern Med. 1947;80:423-434.Crossref 26. Gerstl B, Weidman WH, Newmann AV. Pulmonary aspergillosis: report of two cases . Ann Intern Med. 1948;28:662-671.Crossref 27. Myrowitz RL, Friedman R, Grossman WI. Mycotic 'mycotic aneurysm' of the aorta due to Aspergillus fumigatus . Am J Clin Pathol. 1971;55:241-246. 28. Vo NM, Russell JC, Becker DR. Mycotic embolic of the peripheral vessels: analysis of forty-four cases . Surgery. 1981; 90: 541-545. 29. Feldman C, Mason P, Russell Jones R, Kelley C. Femoral mycotic aneurysm presenting as arthritis and purpura . Br J Rheumatol. 1985;24:364-366.Crossref 30. Merry M, Dunn J, Weismann R, Harris ED. Popliteal mycotic aneurysm presenting as septic arthritis and purpura . JAMA. 1972;221:58-59.Crossref

Journal

Archives of DermatologyAmerican Medical Association

Published: Sep 1, 1990

References