PMC9911907_01
Medical history flow chart.
IDR-16-791-g0001.jpg
PMC9911907_01_IDR-16-791-g0001.jpg
f0001
As the patient remembered, her postprandial glycemia were generally 20-30 mmol/L around tattooing and 13-15 mmol/L around lesion onset (see Figure 1).
Cutaneous aspergillosis on a right lower limb. (A) Papules and erythematous plaques covered with pustular eruption. (B) One month after the initiation of treatment. (C) Three months after the initiation of treatment.
IDR-16-791-g0002.jpg
PMC9911907_01_IDR-16-791-g0002.jpg
f0002
The physical examination revealed only the presence of a cutaneous lesion on the right lower limb and red and blue-black tattoos (Figure 2A). One month after initiating treatment there had been gradual improvement to a certain extent in most lesions (Figure 2B). Complete resolution of lesions was achieved three months after initiating treatment (Figure 2C).
Features of Aspergillus fumigatus. (A) KOH examination shows hyphae under the microscope. (B) Sabouraud dextrose agar media showing the colonies of Aspergillus fumigatus. (C) Aspergillus conidial heads and conidiophores (lactophenol cotton blue).
IDR-16-791-g0003.jpg
PMC9911907_01_IDR-16-791-g0003.jpg
f0003
A KOH (potassium hydroxide) examination revealed visible fungal hyphae under the microscope (Figure 3A). A lesion biopsy specimen was cultured on Sabouraud dextrose agar at 25 C, and numerous and identical fungal colonies grew that were dense, and grey-black in appearance (Figure 3B). Microscopically, the colonies were characterized by septate and hyaline hyphae with columnar conidia 2.5 to 3 microm in diameter, produced in chains basipetally from single palisade-like layer phialides that were borne directly on broadly clavate vesicles (Figure 3C).
Histopathological examination of the skin biopsy. (A) Hematoxylin and eosin, 200x. (B) Periodic acid-Schiff staining shows spores (200x).
IDR-16-791-g0004.jpg
PMC9911907_01_IDR-16-791-g0004.jpg
f0004
The histopathological examination of the skin biopsy revealed a reticulate corneous layer, oval spores in the corneous layer, a slightly thickened epidermis, and in the superficial dermis a few infiltrating lymphocytes and neutrophils around the blood vessels in the superficial dermis (Figure 4A). Periodic acid-Schiff staining was positive, and spores were observed in the cuticle (Figure 4B).