A Rare Case of Cutaneous Sporotrichoid Aspergillus ustus Infection in a Transplant Patient

Aspergillus spp. have long been recognized as human pathogens and are found ubiquitously. Cutaneous infections are an uncommon manifestation of aspergillosis and very rarely present with a sporotrichoid pattern of spread. We present a case of a 50-year-old immunocompromised man with a heart transplant who sustained trauma to his right ankle three weeks prior to presentation. The lesion was subsequently exposed to stagnant water, and he developed a draining nodule at the site of trauma. He soon developed ipsilateral, ascending nodules spreading in a sporotrichoid pattern. A combination of pathology and microbiology was utilized to diagnose the causative organism to be Aspergillus ustus, and fungal sensitivities were vital to provide appropriate treatment. This case is a rare manifestation of aspergillosis. There have only been four other reported cases of cutaneous aspergillosis presenting with a sporotrichoid pattern of spread, and none of these cases identified Aspergillus ustus as the causative organism. This case highlights the importance of utilizing a comprehensive diagnostic approach to diagnose atypical cutaneous infections, as well as the importance of fungal sensitivities to guide effective treatment.