Fatal invasive aspergillosis in a child with chronic granulomatous disease

A rare case of concurrent pneumonia, rib osteomyelitis, spondylodiscitis, paravertebral and epidural abscesses in a patient with chronic granulomatous disease

Chronic granulomatous disease (CGD) is a rare primary immunodeficiency disorder that is characterized by deficiencies in the phagocytes capacity to eliminate ingested microorganisms, which frequently causes bacterial and fungal infections. The extensive involvement of the lungs, ribs, and vertebrae that is complicated by multiple abscesses from aspergillosis is rare. in this study, we report a 13-year-old boy with CGD who experienced concurrent pneumonia, rib osteomyelitis, spondylodiscitis, paravertebral, and epidural abscesses as a result of Aspergillus flavus infection with associated computed tomography scan and magnetic resonance imaging findings. Patients with CGD are susceptible to Aspergillus infection. Correct diagnosis based on clinical and paraclinical findings as well as choosing the best treatment regimen is essential for achieving a favorable outcome.

Mycetoma due to Aspergillus flavus in a diabetic patient: Case report and literature review

Diabetes mellitus patients are prone to cutaneous and subcutaneous fungal infections due to pathogenic fungi, including dermatophytes, Mucorales, Candida, Aspergillus, and Fusarium species. Here, we report a case of A. flavus mycetoma confirmed by isolation and molecular identification. The case was a 38-year-old male farmer with a seven-year history of type 2 diabetes mellitus, living in Khuzestan, southwest of Iran. The patient presented with a right foot swelling associated with a nodule and multiple discharging sinuses following trauma sustained on the foot while working barefoot on the rice farm, a year ago. The nodule appeared at the site of the trauma two months after the injury. The initial diagnosis was based on direct microscopic examination of lesions scraping using 20% potassium hydroxide and radiology. Molecular analysis confirmed the isolates to be A. flavus. In vitro susceptibility of the isolate to voriconazole, posaconazole, caspofungin, itraconazole, and amphotericin B was determined. Treatment with voriconazole (200 mg twice daily) stopped the purulent discharge, reduced the swelling, and improved the clinical condition within two months. The study emphasizes the importance of wearing footwear to prevent skin trauma as the main risk factor of patient involvement.