Aspergillosis complicating the grafted skin and free muscle flap in a diabetic.

Abstract

A case of infected diabetic foot ulcer was reconstructed by a free muscle flap overlaid with a skin graft. Primary cutaneous aspergillosis involving the grafted skin and the transplanted muscle was described. The patient presented with an indurated grey-yellow plaque or black eschar in the wound without purulent discharge. Biopsies and cultures demonstrated A. flavus as the etiologic agent without evidence of systemic dissemination. Early diagnosis necessitates a high index of suspicion in immunocompromised patients with unusual cutaneous manifestation. Treatment consisted of aggressive debridement, systemic and local antifungal therapy, and delayed grafting. We concluded that primary cutaneous aspergillosis may occur at the reconstructed wound in an immunocompromised diabetic, and that it is a rare complication requiring prompt diagnosis and treatment.