Primary Cutaneous Aspergillosis Due to Aspergillus flavus in an Immunocompetent Patient

Zhengfang Wang,1,* Rong Yang,2,* Yonghong Xiao,1 Bo Huang,1 Zhi Yang,1 Luhui Yang1 1Department of Dermatology and Venereology, First Affiliated Hospital of Kunming Medical University, Kunming, 650032, People’s Republic of China; 2Wound and Ostomy Clinic, Outpatient Department, First Affiliated Hospital of Kunming Medical University, Kunming, 650032, People’s Republic of China*These authors contributed equally to this workCorrespondence: Zhi Yang, Department of Dermatology and Venereology, First Affiliated Hospital of Kunming Medical University, No. 295 Xichang Road, Wuhua District, Kunming, Yunnan Province, 650032, People’s Republic of China, Email vipyz@126.com Luhui Yang, Department of Dermatology and Venereology, First Affiliated Hospital of Kunming Medical University, No. 295 Xichang Road, Wuhua District, Kunming, Yunnan Province, 650032, People’s Republic of China, Email lhyang2020@126.comAbstract: Invasive aspergillosis is a life-threatening infection caused by Aspergillus species, affecting the lungs, central nervous system, nasal and orbital regions, and skin. Primary cutaneous aspergillosis (PCA) occurs through direct skin inoculation via trauma, burns, or surgical wounds, with Aspergillus fumigatus, Aspergillus flavus, and Aspergillus niger as common causative species, and is rare in immunocompetent individuals. We report a case of PCA in a 56-year-old immunocompetent patient with facial and right ankle ulcers, persisting for two years. The patient had no history of diabetes, corticosteroid use, or immunodeficiency. Fungal culture and metagenomic next-generation sequencing (mNGS) confirmed A. flavus infection. Voriconazole therapy, surgical debridement, and specialized wound care led to the gradual healing of the ulcers. This case highlights the importance of early diagnosis and intervention to prevent infection spread and progression to systemic aspergillosis or septic shock.Keywords: invasive aspergillosis, primary cutaneous aspergillosis, A. flavus, fungal infection