Cutaneous Nodule Revealing Aspergillosis in an Immunocompete
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The primary cutaneous localization of Aspergillosis on immunocompetent patients is exceptional and poorly characterized. Cutaneous Aspergillosis produces several types of lesions and can take various forms; therefore, the clinical aspect is not specific. The semiological similarity of these lesions with those of a hemangioma could lead to a diagnostic wandering and a delay in the therapeutic management, so the diagnosis is based on histopathological examination.

A 58-year-old housewife with unremarkable clinical history was presented for a chronic lesion evolving for 9 months after a leg trauma. On clinical examination, it was a well, circumscribed nodular lesion with hard consistency localized in her right leg. This lesion was isolated without any other associated signs. With such a clinical presentation, clinicians suggested the diagnosis of hemangioma. The patient underwent surgical excision of her lesion.

Histological examination of the resected cutaneous specimen showed a regular epidermidis with normal squamous epithelium, in the dermis, there were numerous hyphae with right-angle branching. These branching hyphae stained positive for PAS staining. These features were consistent with the diagnosis of cutaneous Aspergillosis. Additional clinical investigations did not find any other locations of the disease, thus excluding hematogenous dissemination that could result in secondary skin lesions. These investigations also ruled out any immunocompromised status in patients. The patient was completely cured by systemic voriconazole prescription, with no signs of the disease.

Primary Cutaneous Aspergillosis is extremely rare in immunocompetent patients. It has often misleading clinical presentations. Chronic isolated skin lesions in immunocompetent patients should raise the possibility of Cutaneous Aspergillosis. The correct diagnosis relies on the histopathological or microbiological analysis of the lesion.