Primary Post-Traumatic Aspergillus fumigatus Soft-Tissue Infection of the Hand Requiring Digital Amputation and Reconstruction: A Case Report
5 affiliations
- 1Second Department of Surgery, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece
- 2Department of General Surgery, Spital Herisau, 9100 Herisau, Switzerland
- 3Department of Surgery, General Hospital of Lamia, 35100 Lamia, Greece
- 4Department of Cardiothoracic and Vascular Surgery, Westpfalz Klinikum, 67655 Kaiserslautern, Germany
- 5Department of Orthopaedics, University Hospital of Patras, 26504 Patras, Greece
Abstract
Background: Primary post-traumatic aspergillosis is an uncommon fungal infection resulting from direct inoculation of Aspergillus species into disrupted skin and soft tissue. Although it is more frequently encountered in immunocompromised patients, severe localized infection may also occur after traumatic inoculation, particularly in the presence of previously unrecognized predisposing conditions. Involvement of the hand is rare. Case Presentation: A 68-year-old man was referred to our department with a progressive necrotizing infection of the right hand following an occupational agricultural injury. The initial injury had been surgically treated at another institution. On presentation, extensive necrosis involved the palmar aspect of the hand; the index, middle, and ring fingers; and the hypothenar region. The patient had no known systemic condition predisposing him to fungal infection at presentation. During hospitalization, however, persistent hyperglycemia led to the diagnosis of previously unrecognized and uncontrolled diabetes mellitus. Surgical exploration revealed extensive soft-tissue necrosis, thrombosed vessels, poorly perfused and friable tendinous structures, and exposed bony structures of the middle and ring fingers. Aspergillus fumigatus was repeatedly isolated from wound and deep-tissue specimens. Antifungal therapy was initially started with amphotericin B but was discontinued because of a severe allergic reaction and replaced with voriconazole. Three sequential surgical debridements were performed. Magnetic resonance imaging demonstrated extensive soft-tissue involvement without evidence of osteomyelitis. A fourth operation combined further debridement with amputation of the irreversibly damaged middle and ring fingers and immediate reconstruction of the resulting defect with local flap coverage. Subsequent cultures were negative, and the postoperative course was uncomplicated. Conclusions: Post-traumatic A. fumigatus infection of the hand is rare but may lead to extensive soft-tissue destruction. An invasive fungal infection should be considered in progressive necrotizing wounds following contaminated trauma, particularly when the clinical course is atypical or refractory to conventional antibacterial treatment. Early microbiological diagnosis, systemic antifungal therapy, repeated surgical debridement, and recognition of underlying predisposing conditions are essential for successful management.
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BibTeX
@article{mitropoulou2026primary,
title = {{Primary Post-Traumatic Aspergillus fumigatus Soft-Tissue Infection of the Hand Requiring Digital Amputation and Reconstruction: A Case Report}},
author = {Anna-Maria Mitropoulou and Francesk Mulita and Panagiotis Dimitrios Papadopoulos and Dimitrios Litsas and Vasileios Leivaditis and Panagiotis Antzoulas and Antonios Katsantonis and Helen Bolanaki and Anastasios J. Karayiannakis},
journal = {Journal of Clinical Medicine},
year = {2026},
month = nov,
doi = {10.3390/jcm15218667},
url = {https://www.mdpi.com/2077-0383/15/21/8667},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Primary Post-Traumatic Aspergillus fumigatus Soft-Tissue Infection of the Hand Requiring Digital Amputation and Reconstruction: A Case Report
AU - Anna-Maria Mitropoulou
AU - Francesk Mulita
AU - Panagiotis Dimitrios Papadopoulos
AU - Dimitrios Litsas
AU - Vasileios Leivaditis
AU - Panagiotis Antzoulas
AU - Antonios Katsantonis
AU - Helen Bolanaki
AU - Anastasios J. Karayiannakis
PY - 2026
DA - 2026/11/06
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218667
UR - https://www.mdpi.com/2077-0383/15/21/8667
AB - Background: Primary post-traumatic aspergillosis is an uncommon fungal infection resulting from direct inoculation of Aspergillus species into disrupted skin and soft tissue. Although it is more frequently encountered in immunocompromised patients, severe localized infection may also occur after traumatic inoculation, particularly in the presence of previously unrecognized predisposing conditions. Involvement of the hand is rare. Case Presentation: A 68-year-old man was referred to our department with a progressive necrotizing infection of the right hand following an occupational agricultural injury. The initial injury had been surgically treated at another institution. On presentation, extensive necrosis involved the palmar aspect of the hand; the index, middle, and ring fingers; and the hypothenar region. The patient had no known systemic condition predisposing him to fungal infection at presentation. During hospitalization, however, persistent hyperglycemia led to the diagnosis of previously unrecognized and uncontrolled diabetes mellitus. Surgical exploration revealed extensive soft-tissue necrosis, thrombosed vessels, poorly perfused and friable tendinous structures, and exposed bony structures of the middle and ring fingers. Aspergillus fumigatus was repeatedly isolated from wound and deep-tissue specimens. Antifungal therapy was initially started with amphotericin B but was discontinued because of a severe allergic reaction and replaced with voriconazole. Three sequential surgical debridements were performed. Magnetic resonance imaging demonstrated extensive soft-tissue involvement without evidence of osteomyelitis. A fourth operation combined further debridement with amputation of the irreversibly damaged middle and ring fingers and immediate reconstruction of the resulting defect with local flap coverage. Subsequent cultures were negative, and the postoperative course was uncomplicated. Conclusions: Post-traumatic A. fumigatus infection of the hand is rare but may lead to extensive soft-tissue destruction. An invasive fungal infection should be considered in progressive necrotizing wounds following contaminated trauma, particularly when the clinical course is atypical or refractory to conventional antibacterial treatment. Early microbiological diagnosis, systemic antifungal therapy, repeated surgical debridement, and recognition of underlying predisposing conditions are essential for successful management.
SN - 2077-0383
ER -