Pseudoepitheliomatous hyperplasia secondary to cutaneous aspergillus

Cutaneous aspergillosis commonly occurs in immunocompromised hosts and may also complicate burn wounds. Pseudoepitheliomatous hyperplasia (PH) is a hi stologic reaction secondary to a wide range of stimuli, including fungal in fection. We describe a case of an 18-year-old man, status-post burns over 7 0% of his total body surface area, with cutaneous aspergillosis of the axil la and secondary PH. A single case of PH secondary to primary aspergillosis has been described in the larynx but, to our knowledge, has never been des cribed cutaneously. Histologic examination of the lesion reveals an irregul arly acanthotic epidermis with deep invaginations within the dermis. There is an intense inflammatory reaction within the superficial and deep dermis. Numerous fungal forms are identified within the dermis. Special stains dem onstrate septate hyphae with dichotomous branching, which is morphologicall y consistent with Aspergillus. Therefore, we conclude that cutaneous asperg illosis should be included in the differential diagnosis of causes of PH, e specially in a patient population at risk for this infection.