Primary Cutaneous Aspergillosis Caused by <i>Aspergillus fumigatus</i> in an Immunocompetent Host: A Rare Case Report with Diagnostic and Therapeutic Insights

Abstract

Introduction: Primary cutaneous aspergillosis (PCA) is an uncommon manifestation of Aspergillus infection that typically occurs in immunocompromised hosts but has rarely been reported in immunocompetent individuals after traumatic inoculation. Its clinical presentation is often nonspecific and may mimic a broad range of infectious and inflammatory dermatoses, making diagnosis challenging. Case Presentation: A 47-year-old immunocompetent male farmer presented with an 8-month history of a progressively enlarging, painful, erythematous plaque on his right forearm. Histopathology demonstrated granulomatous inflammation; Gomori methenamine silver and periodic acid-Schiff stains revealed fungal elements, and fungal culture identified Aspergillus fumigatus. The patient was intolerant to amphotericin B and showed no response to itraconazole but improved markedly with prolonged oral voriconazole therapy. Conclusions: This case report emphasizes that primary cutaneous aspergillosis should be included in the differential diagnosis for chronic cutaneous lesions, even in immunocompetent individuals, and highlights the roles of histopathology, fungal culture, and appropriate systemic antifungal therapy.