Ulcerative lupus vulgaris

Aspergillus species are among the most ubiquitous fungi, seen in soil, water, decaying vegetations and any substrate that contains organic debris. The respiratory tract is the most common primary portal of entry. After candida albicans, the aspergillus species is the second most common cause of human opportunistic fungal infection. Our patient was taking oral corticosteroids for more than one year for chronic dermatitis, which could have caused immunosuppression. Cutaneous aspergillosis has been reported earlier in two patients on high doses of corticosteroids. [5] Our patient presented with multiple cutaneous nodules with nail involvement. A larger nodule on the finger was excised. The histopathologic examination of the nodule confirmed the diagnosis and GMS stain demonstrated the fungi inside the vessel wall. Aspergillus flavus species was identified in the culture. The sites colonized by aspergillus include paranasal sinuses, the external auditory meatus and dystrophic nails. In our patient, nail infection could explain the source of fungi inside the vessel wall of skin lesions. Although voriconazole has been found very effective it was not available and hence we treated the patient with itraconazole. We report this case for its interesting clinical features, rarity of occurrence and to highlight the hazards of prolonged intake of oral steroids.