Abstract
We reported a case of primary cutaneous aspergillosis in a female neonate who was born by cesarean section at 22 weeks weighing 326 grams. She was on ventilator management in an incubator at the neonatal intensive care unit. On day 3 after birth, she developed a blister that extended from the right chest to the abdomen and soon expanded to the right thigh. Blood examination revealed a serum β-D-glucan level of 5330 pg/mL. Chest radiography showed no evidence of pulmonary aspergillosis. Fungal elements were found out by direct microscopy from skin lesions. Cultures using Sabouraud dextrose agar yielded colonies that showed a suede-like surface with blue-green pigmentation. The slide-culture findings were characteristic of Aspergillus fumigatus, and the strain was identified as the same based on gene sequence analysis. Fluconazole was administered immediately on day 6 after birth. Though the dose was increased and the therapy was switched to amphotericin B on day 7 after birth, her skin lesions progressed and showed necrosis. Her general condition worsened, and she died on day 16 after birth. Later, antifungal susceptibility test revealed that micafungin, an echinocandin antifungal agent, was the most effective for this strain. Since 1980, there have been some reports of primary cutaneous aspergillosis occurring in low-birth-weight neonates. Most of them are treated with amphotericin B alone, but the latest guidelines in Japan recommend echinocandin antifungal drugs as the first choice. Dermatologists rarely administer echinocandin antifungal drugs, and clinical susceptibility tests for fungi are not routinely performed. In this case, amphotericin B administration did not improve the symptoms, and it was considered that administration of echinocandin antifungal drug should be considered. The number of patients with a similar clinical presentation is likely to increase in future. Close coordination between neonatologists and dermatologists is warranted to effectively treat this disease.
