ASPERGILLUS - A RARE PRIMARY ORGANISM IN SOFT-TISSUE INFECTIONS

Nonclostridial necrotizing soft-tissue infections are usually polymicr obial, with greater than 90 per cent involving P-hemolytic streptococc i or coagulase-positive staphylococci. The remaining 10 per cent are u sually due to Gram-negative enteric pathogens. We describe the case of a 46-year-old woman with bilateral lower extremity fungal soft tissue infections. She underwent multiple surgical debridements of extensive gangrenous necrosis of the skin and subcutaneous fat associated with severe acute arteritis. Histopathological examination revealed Aspergi llus niger as the sole initial pathogen. Despite aggressive surgical d ebridement, allografts, and intravenous amphotericin B, her condition clinically deteriorated and she ultimately died of overwhelming infect ion. Treatment for soft-tissue infections include surgical debridement and intravenous antibiotics. More specifically, Aspergillus can be tr eated with intravenous amphotericin B, 5-fluorocytosine, and rifampin. Despite these treatment modalities, necrotizing fascitis is associate d with a 60 per cent mortality rate. Primary fungal pathogens should b e included in the differential diagnosis of soft-tissue infections.