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Aspergillosis has been used to describe tissue invasion, allergy, or colonization with the mold Aspergillus, which is found ubiquitously worldwide in decaying vegetation, soil, water, food, and plants. In this instance we describe life-threatening, invasive aspergillosis in the immunocompromised host. Invasive aspergillosis typically affects the lungs and, through hematogenous dissemination, the kidney, heart, brain, sinuses, and skin. Patients with chronic granulomatous disease, human immunodeficiency virus, or malignancy treated by chemotherapy, and patients using immunosuppressive medications are at risk for acute, rapidly progressive pneumonia and multisystem involvement. Primary cutaneous aspergillosis has been described at IV sites and under tape. In invasive aspergillosis, death often ensues, despite aggressive therapy.

A variety of skin lesions may be seen: cellulitis, solitary plaques, subcutaneous nodules, widespread papules, and pustular lesions. Because Aspergillus is vessel invasive, purpuric and necrotic changes usually evolve. The cutaneous lesions in primary cutaneous aspergillosis have been described as erythematous, umbilicated papules, similar to molluscum contagiosum.

In the immunocompromised patient, consider this diagnosis when scattered pustular lesions are present.

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