SURGICAL-WOUND HEALING COMPLICATED BY ASPERGILLUS INFECTION IN A NONIMMUNOCOMPROMISED HOST

BACKGROUND. An unusual complication of cutaneous surgery and its manag ement is presented. Aspergillus flavus was identified from a nonhealin g surgical wound of the ear undergoing cartilaginous necrosis in an im munocompetent host. OBJECTIVE. We wish to alert clinicians that Asperg illus may infect surgical wounds of the ear causing significant morbid ity. METHOD. A healthy man underwent Mohs micrographic surgery for inv asive Bowen's disease of the ear. Due to the size and location of the defect it was allowed to heal by secondary intent. The patient develop ed inflammation and subsequent destruction of the ear cartilage. Asper gillus was demonstrated by touch preps and cultured from swabs and tis sue from the necrotic wound. RESULTS. In spite of aggressive topical a nd oral antifungal therapy severe distortion of the pinna occurred, re sulting in surgical removal of the upper two-thirds of the ear. CONCLU SIONS. In the presence of cartilage necrosis following surgery on the ear, Aspergillus infection should be considered. Early aggressive mana gement with surgical debridement, and topical and oral antifungal ther apy may prevent destruction of the cartilage and a significant cosmeti c defect.