Primary Cutaneous Aspergillosis in Disguise: A Case Report with Diagnostic Insights from Cytology and Literature Review.

INTRODUCTION

Primary Cutaneous Aspergillosis (PCA) is a rare localized fungal infection resulting from direct skin inoculation of Aspergillus species, often affecting immunocompetent indi-viduals following minor trauma. Unlike systemic forms, which are predominant in immunocompro-mised hosts, PCA frequently mimics benign subcutaneous lesions, leading to diagnostic delays and mismanagement.</p> Case presentation: A total of 3 cases of adult males (aged 55-70 years) were reported: two immuno-competent and one with controlled type 2 diabetes. Lesions presented as painless, mobile subcutane-ous swellings on the left elbow (24 months), shin (6 months), and lower leg (4 months), clinically mimicking lipoma, sebaceous cyst, or olecranon bursitis. Risk factors included repetitive soil expo-sure or superficial abrasion. Fine-Needle Aspiration Cytology (FNAC) with Gomori Methenamine Silver (GMS) staining revealed suppurative inflammation and acute-angle branching septate hyphae. Cultures grew Aspergillus flavus (two cases) and A. fumigatus (one case). For all three cases, wide local excision was planned and performed. Antifungal therapy was administered, which included oral Voriconazole for 8 weeks in two cases and intravenous liposomal Amphotericin B for 14 days fol-lowed by Voriconazole for 6 weeks in the third patient, who was diabetic. No recurrence was ob-served at the 12-month follow-up.

CONCLUSION

FNAC with GMS staining is a rapid, low-cost tool that prevents inappropriate surgery and enables early targeted therapy. Clinicians should incorporate FNAC into diagnostic algorithms for atypical subcutaneous swellings with trauma history to avert dissemination and ensure excellent outcomes.