Fatal Nasal Aspergillosis in an Immunocompromised Pediatric Patient

Abstract

Invasive aspergillosis is an opportunistic infection associated with immunosuppression and prolonged neutropenia, particularly in critically ill pediatric patients. High-dose corticosteroid use is recognized as an additional risk factor. The disease may follow a rapidly progressive course with dissemination to the lungs and central nervous system, and is associated with high mortality. Early diagnosis through tissue biopsy is essential, and treatment is based on amphotericin B and voriconazole.

We report the case of a 2-year-old female patient with no relevant personal or family history, admitted to the Pediatric Intensive Care Unit due to aortitis and postoperative complications following open-heart surgery. She received high-dose corticosteroid pulses and subsequently developed severe leukopenia and profound neutropenia. During her hospitalization, she presented a flattened violaceous nasal lesion with whitish eschars, which progressed to necrosis within 48 hours. Bacterial cultures were negative, and biopsy revealed histopathological findings consistent with Aspergillus spp. Invasive aspergillosis was diagnosed in the context of immunocompromise due to neutropenia and corticosteroid therapy. The patient died 60 hours after the onset of the skin lesion.

The identification of necrotizing cutaneous lesions in neutropenic patients should raise suspicion for invasive fungal infection. This case highlights the importance of early clinical recognition in pediatric intensive care units. It underscores the poor prognosis associated with profound neutropenia and the need for timely preventive and therapeutic strategies to reduce mortality in critically ill immunocompromised pediatric patients with rapidly progressive and highly lethal invasive fungal infections.