A novel type of metastatically spreading subcutaneous aspergillosis without epidermal lesions following allogeneic stem cell transplantation

Systemic mycosis is among the most feared opportunistic infections in the i mmunocompromised host. Difficulty and delay in diagnosis and treatment ofte n result in poor outcomes. In this communication a metastatically spreading form of subcutaneous aspergillosis developed in a patient with a history o f allogeneic stem cell transplantation for relapsed Hodgkin's lymphoma. Str ikingly, necrotizing cutaneous papules or ulcerating lesions were absent. D iagnosis was accomplished after excision of a clinically non-suggestive sub cutaneous nodule. Despite prompt initiation of antimycotic therapy the outc ome was fatal; dosage of conventional and liposomal amphotericin B was limi ted due to treatment-related toxicities. This case report describes a novel form of aspergillosis and underlines the need for an aggressive diagnostic approach in severely immunocompromised patients.