Surgical management of a local angioinvasive fungal soft tissue infection in the knee: a case report

A 58-year-old male with an insignificant past medical history presented with chronic myelogenous leukemia in blast crisis. He began induction chemotherapy complicated by neutropenic fever. The patient then developed a nontender 1.5 cm violaceous firm indurated papule above the left patella with satellite lesions on his wrist and chest. A biopsy of the left patella showed obliterated blood vessels in the deep reticular dermis and numerous hyphae with septation and acute angle branching in the vessel wall consistent with angioinvasive aspergillosis. He was started on liposomal amphotericin and empiric voriconazole. Urgent local surgical excision of the primary lesion was recommended for source control. There is no clear recommendation on surgical intervention for angioinvasive aspergillosis, and further direction is needed. We present a case that illustrates surgical debridement for angioinvasive aspergillosis to be an effective method of source control along with systemic antifungal therapy.