Primary Cutaneous Aspergillosis Presenting as a Multiloculated Cyst in the Hand

Abstract

Invasive aspergillosis typically occurs in immunocompromised patients and results in fatal complications. Musculoskeletal involvement of aspergillosis is extremely rare, therefore, when it occurs, its diagnosis and treatment could be delayed. In this paper, we report a rare case of primary invasive aspergillosis with radiologic findings in a patient with rheumatoid arthritis. A 57-yearold woman presented a palpable mass on the right hand with a previous medical history of long-term use of immunosuppressive agents due to rheumatoid arthritis. Magnetic resonance imaging showed a multilobulated and multiloculated cystic lesion with an enhancing wall. The wall of the cystic lesion showed low signal intensity on T2 weighted images and intermediate to high signal intensity on T1 weighted images. The mass was confirmed as chronic granulomatous inflammation with multiple acute branching and septated fungal hyphae, consistent with invasive aspergillosis. When a superficial multicystic mass in the hand of especially immunocompromised patients is encountered, invasive aspergillosis should be included in the differential diagnosis, although it is rare.

Primary cutaneous aspergillosis presenting as a cystic lesion in the foot

“…Hyphal invasion in an immunocompromised patient may lead to angioinvasion that induces ulcer and necrosis, a further extension to adjacent osseous structure and soft tissue, and even hematogenous systemic dissemination to any organ. 3 Therefore, rapid diagnosis and treatment are important. Early diagnosis and appropriate surgical debridement and antifungal agent therapy significantly reduced mortality and morbidity in these patients.…”

“…Early diagnosis and appropriate surgical debridement and antifungal agent therapy significantly reduced mortality and morbidity in these patients. 3 For this reason, in the presence of soft-tissue abscesses and other cutaneous lesions with immunosuppressive patients, Aspergillus infections should be considered as a reason. Here, we have presented a rare case of primary cutaneous aspergillosis of the foot which presented as a cystic lesion in a patient with no known risk factors.…”

“…1 Aspergillosis causes pulmonary infection in the majority of cases. 3 Cutaneous aspergillosis is a rarely encountered form of aspergillosis. 1 Here, we present a case of primary cutaneous aspergillosis presenting as a cystic lesion in the foot of a 54-year-old female without any known risk factors.…”