Primary Cutaneous Aspergillosis in a Premature Neonate- A Case Study

Primary Cutaneous Aspergillosis in a Premature Neonate- A Case Study

Primary Cutaneous Aspergillosis (PCA) is an extremely rare opportunistic fungal infection resulting in a high mortality, especially in neonates. Fungal infections in the neonate, other than those caused by Candida, are uncommon, and therefore, are often overlooked or wrongly diagnosed. Premature neonates are at increased risk for fungal infections due to their immature immune system and altered skin barrier function. In all reported cases of PCA there is an initial break in the skin which is often correctly identified as a Medical Adhesive Related Skin injury (MARSI) or Medical Device Related Pressure Injury (MDRPI). However, the patient may also present with seemingly unrelated skin changes such as erythema or a rash that should be taken into consideration as part of this cutaneous process. We present the case of a former 23 4/7 week gestation and now 1 week old premature male infant with successfully treated PCA. Upon arrival to the NICU, the neonate weighed 670 grams (1 lb., 7.6 ounces), and had a right hip 3 cm x 2 cm dark eschar and a corresponding left hip area of redness. Darkened erythema was also noted to the abdomen. Two days later, he developed a pink, macular rash to his back that later became grey and then black with green drainage. Tissue cultures from both the back and the hip sites revealed MRSA and Aspergillosis Fumigatus. The patient completed courses of IV Amphotericin B and Vancomycin. Topical wound care included Mupirocin ointment and Clotrimazole cream to the affected sites and a thin hydrocolloid dressing to protect the peri-wound skin. This case study shows the importance of suspecting PCA in extremely low birth weight neonates with rapid progression of cutaneous symptoms. Timely recognition and treatment can lead to survival.