Cutaneous invasive aspergillosis in a patient with glioblastoma receiving long-term temozolomide and corticosteroid therapy

• Published in: Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy Vol. 23; no. 4; pp. 253 - 255
• Main Authors: Ikeda, Takashi, Suzuki, Jun, Norizuki, Masataro, Okabe, Taro, Onishi, Tsubasa, Sasahara, Teppei, Toshima, Masaki, Yokota, Hidenori, Hatakeyama, Shuji, Morisawa, Yuji
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.04.2017
• Subjects: Adrenal Cortex Hormones - administration & dosage; Adrenal Cortex Hormones - adverse effects; Aged; Aspergillosis - chemically induced; Brain Neoplasms - drug therapy; Combined Modality Therapy - methods; Corticosteroids; Cutaneous invasive aspergillosis; Dacarbazine - administration & dosage; Dacarbazine - adverse effects; Dacarbazine - analogs & derivatives; Female; Glioblastoma; Glioblastoma - drug therapy; Hematology, Oncology and Palliative Medicine; Humans; Skin - microbiology; Temozolomide; Cutaneous invasive aspergillosis; Corticosteroids; Temozolomide; Glioblastoma
• ISSN: 1341-321X; 1437-7780
• DOI: 10.1016/j.jiac.2016.10.004

Abstract Glioblastoma is an aggressive brain tumor that requires multidisciplinary treatment including adjuvant radiotherapy, chemotherapy, and adjunct corticosteroids. Temozolomide is a commonly used chemotherapy drug and frequently causes lymphocytopenia. We describe the case of a 67-year-old woman with cutaneous invasive aspergillosis who had received long-term temozolomide and corticosteroid therapy for glioblastoma. She presented with multiple indurations, erythema, and purpura, some of which produced purulent discharge, in the anterior abdomen. Extensive intra- or inter-muscular abscesses of the right anterior abdominal wall were also observed. Her absolute lymphocyte counts were 156/μL on admission. Cultures obtained from the wound yielded Aspergillus fumigatu s. She was diagnosed with secondary cutaneous invasive aspergillosis, which likely resulted from hematogenous dissemination. Although rare, this case illustrates that temozolomide-induced lymphocytopenia, especially in cases of concomitant corticosteroid use, can be associated with severe invasive aspergillosis.