Primary Cutaneous Aspergillosis Caused by Aspergillus terreus: A Case Report

Background: Primary cutaneous aspergillosis attributable to Aspergillus terreus represents an uncommon opportunistic fungal infection predominantly observed in immunocompromised individuals; however, it can also manifest in immunocompetent patients subsequent to trauma or invasive interventions. Case Presentation: We present a case of a 16-year-old male with juvenile diabetes mellitus who developed primary cutaneous aspergillosis marked by a painful, erythematous keloid scar on the chin accompanied by purulent discharge. The patient's medical history includes a recent intralesional steroid injection three weeks before presentation, keloid formation, and surgical excision of a mole nine months prior. Direct microscopic examination of aspirated pus revealed septate, acute-angle branching hyaline hyphae indicative of Aspergillus species. Fungal culture yielded cinnamon-brown, suede-like colonies, and the isolate was microscopically identified as Aspergillus terreus, a diagnosis further substantiated by gene sequencing demonstrating 99% homology. Early diagnosis and treatment with oral itraconazole and topical terbinafine resulted in clinical improvement. Conclusion: This case highlights Aspergillus terreus as a rare cause of primary cutaneous aspergillosis, emphasising early microbiological diagnosis and timely antifungal treatment in patients with diabetes.