Primary cutaneous aspergillosis is rare. In this report we describe primary skin infection by Aspergillus in 9 children with leukemia. The skin lesion was characterized clinically by erythematous macule and papule associated with pain and
itching,
followed by a rapid progression to ulcer and central black eschars with raised erythematous border at the site of venipuncture, insertion of intravenous cannula, or where arm boards had been taped to extremities. Diagnosis was confirmed by skin
biopsy
and wound culture. Positive revealed in 6 patients, including A. glaucus in 2 cases, A. flavus in 1 case. Treatment consisted of temporary withdrawl of anticancer chemotherapy, intravenous amphotericin B, oral flucytosine, itraconazole and/or
rifampin.
One patient recovered completely without antifungal medication with resolution of leukopenia. Six of eight treated patients recovered. One patient discharged against medical advice, while cutaneous aspergillosis was improving. One patient died
with
persistent skin lesion and neutropenia.
We conclude that primary cutaneous aspergillosis is increasingly recognized in association with intravenous cannula, intravenous puncture or prolonged contact with arm boards in immunocompromised patients, and that this serious disease can be
treated
successfully with appropriate management.
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