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

Bone Marrow Transplant. 2001 Nov;28(9):899-901. doi: 10.1038/sj.bmt.1703250.

Abstract

Systemic mycosis is among the most feared opportunistic infections in the immunocompromised host. Difficulty and delay in diagnosis and treatment often result in poor outcomes. In this communication a metastatically spreading form of subcutaneous aspergillosis developed in a patient with a history of allogeneic stem cell transplantation for relapsed Hodgkin's lymphoma. Strikingly, necrotizing cutaneous papules or ulcerating lesions were absent. Diagnosis was accomplished after excision of a clinically non-suggestive subcutaneous nodule. Despite prompt initiation of antimycotic therapy the outcome was fatal; dosage of conventional and liposomal amphotericin B was limited 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.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Amphotericin B / therapeutic use
  • Antifungal Agents / therapeutic use
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Aspergillosis / diagnosis
  • Aspergillosis / drug therapy
  • Aspergillosis / etiology
  • Aspergillosis / pathology*
  • Bleomycin / administration & dosage
  • Carmustine / administration & dosage
  • Combined Modality Therapy
  • Cyclophosphamide / administration & dosage
  • Cytarabine / administration & dosage
  • Dacarbazine / administration & dosage
  • Deoxycytidine / administration & dosage
  • Deoxycytidine / analogs & derivatives*
  • Dexamethasone / administration & dosage
  • Doxorubicin / administration & dosage
  • Etoposide / administration & dosage
  • Fatal Outcome
  • Gemcitabine
  • Hematopoietic Stem Cell Transplantation*
  • Hodgkin Disease / complications*
  • Hodgkin Disease / drug therapy
  • Hodgkin Disease / radiotherapy
  • Hodgkin Disease / therapy
  • Humans
  • Immunocompromised Host
  • Klebsiella Infections / complications
  • Klebsiella Infections / drug therapy
  • Klebsiella pneumoniae / isolation & purification
  • Lung Diseases, Fungal / diagnosis
  • Lung Diseases, Fungal / drug therapy
  • Lung Diseases, Fungal / etiology
  • Male
  • Melphalan / administration & dosage
  • Neoplasm Recurrence, Local
  • Opportunistic Infections / diagnosis
  • Opportunistic Infections / drug therapy
  • Opportunistic Infections / etiology
  • Opportunistic Infections / pathology*
  • Pneumonia, Bacterial / complications
  • Pneumonia, Bacterial / drug therapy
  • Pneumonia, Pneumocystis / complications
  • Pneumonia, Pneumocystis / drug therapy
  • Prednisone / administration & dosage
  • Procarbazine / administration & dosage
  • Salvage Therapy
  • Skin
  • Transplantation, Homologous
  • Vinblastine / administration & dosage
  • Vincristine / administration & dosage

Substances

  • Antifungal Agents
  • Cytarabine
  • Deoxycytidine
  • Bleomycin
  • Procarbazine
  • Vincristine
  • Vinblastine
  • Etoposide
  • Dacarbazine
  • Dexamethasone
  • Amphotericin B
  • Doxorubicin
  • Cyclophosphamide
  • Melphalan
  • Carmustine
  • Prednisone
  • Gemcitabine

Supplementary concepts

  • ABVD protocol
  • CBV protocol
  • COPP protocol
  • Dexa-BEAM protocol