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.