Primary Cutaneous Aspergillosis in a Preterm Infant

Abstract

Primary cutaneous aspergillosis is rare in premature infants. It requires combined medical and surgical strategies. Liposomal amphotericin B is recommended as first-line therapy, but salvage regimens with others antifungal agents, such as voriconazole, have been reported. Voriconazole's pharmacodynamics is unknown in this population. We report a case of severe toxicity to voriconazole in a preterm patient with primary cutaneous aspergillosis.

Erythematous plaque and vesicular lesions in an extremely premature newborn

“…Despite having extensive cutaneous involvement, disseminated aspergillosis was absent. Similar to this case, poor or partial responses to amphotericin B have been reported in neonates who therefore required combination treatment . Surgical debridement, commonly used in adult PCA, is not a good option in preterm infants due to extreme skin immaturity .…”

“…The current case is unique for being the lowest gestational age and lowest birthweight preterm infant with PCA to have been successfully managed with medical treatment . Despite having extensive cutaneous involvement, disseminated aspergillosis was absent.…”

“…Based on the initial clinical evaluation, three principal differential diagnoses were considered, including cutaneous fungal infection, The current case is unique for being the lowest gestational age and lowest birthweight preterm infant with PCA to have been successfully managed with medical treatment. 1,2 Despite having extensive cutaneous involvement, disseminated aspergillosis was absent.…”

“…Surgical debridement, commonly used in adult PCA, is not a good option in preterm infants due to extreme skin immaturity . Intravenous voriconazole has been tried but lacks safety data in this age group . Given these limitations, the addition of topical 3% amphotericin B was an effective therapeutic alternative for our patient.…”

Expanding eschar in an immunocompromised premature infant

“…Reported cases of aspergillosis and mucormycosis in neonates describe successful treatment with a combination of aggressive surgical debridement and amphotericin B . Systemic voriconazole has been used as an alternative in non‐responders, but there are no formal safety data on its use in premature neonates …”