Cutaneous aspergillosis and acquired immunodeficiency syndrome

Background: Primary cutaneous aspergillosis is an uncommon finding in patie nts with acquired immunodeficiency syndrome (AIDS); only 13 cases have been reported in the literature. Observations: We describe 11 patients with primary cutaneous aspergillosis and AIDS. There does not seem to be an age, sex, race, or human immunodefic iency virus risk factor predisposition. This is a late manifestation of AID S, patients typically have low CD4 counts (<0.050 X 10(9)/L [<50/mu L]) and other AIDS-defining illnesses. The most frequent presentation is in patien ts with cytomegalovirus disease and neutropenia caused by ganciclovir thera py. Lesions developed at the site of occlusive dressings for an indwelling intravenous catheter site in 10 patients. Neutrophil counts may be normal a t the time of diagnosis. A minor presentation is in the patient without neu tropenia as a result of traumatic inoculation. Histological findings and/or culture results are required for diagnosis. Patients develop cutaneous les ions despite prophylactic therapy with fluconazole. Lesions can be treated with excision and lifelong therapy with itraconazole. Conclusion: Because of the potential morbidity and mortality of cutaneous a spergillosis, a high level of suspicion and prompt institution of therapy i s required.