Discussion
It is estimated that invasive cutaneous aspergillosis represents up to 5% for all invasive aspergillosis 10, Invasive cutaneous aspergillosis represents a challenge in diagnosis, as lesions have no specific characteristics and tend to resemble lesions of any other skin pathologies 6 with secondary escharotic evolution 11, due to neutral behavior of lesions skin biopsy and culture may be delayed.
Early identification of invasive aspergillosis and initiation of antifungal therapy is crucial in the management of invasive, alleviation of immunosuppression and surgical intervention is needed to eradicate the infection when feasible, and the lesion is amenable to surgery.
Three classes of antifungals are available, azoles, polyenes, and echinocandins, with a Cochrane review showed the superiority of liposomal amphotericin B over azoles in the treatment of invasive aspergillosis in patients with persistent neutropenia12, duration of treatment depends on the site of infection, immune status of the patient and response to therapy, a minimum duration of 6 – 12 weeks is needed but most of the time patients will require antifungal therapy for months or even years in some instances 13.
Surgery is advised in localized disease as our patient, but usually, immunosuppressed patients are less likely to tolerate surgery due to bleeding and increase the risk of superadded infections because of thrombocytopenia and leukopenia respectively.