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<p>Primary cutaneous aspergillosis (PCA) is a rare fungal infection that primarily affects immunocompromised individuals but can occasionally occur in healthy people through traumatic inoculation or surgical wounds. The clinical manifestations vary depending on the host’s immune status, often mimicking conditions like ganglion cysts or abscesses, making early diagnosis challenging. In this case, a 47-year-old female presented with a cystic swelling on her right hand, initially suspected to be a ganglion cyst based on imaging. However, accompanying joint deformities, brittle nails, and raised inflammatory markers raised concerns about underlying rheumatoid arthritis. Histopathological examination post-excision confirmed the presence of necrotizing granulomatous inflammation of fungal origin, identifying Aspergillus species. This case highlights the diagnostic difficulty in differentiating PCA from other cystic lesions, especially in immunocompetent individuals with underlying conditions. Although rheumatoid arthritis does not inherently cause systemic immunosuppression, previously undiagnosed RA may predispose patients to infection. The chronic autoimmune inflammation and resultant local tissue vulnerability weaken host defenses, thereby facilitating opportunistic infection. Histopathology played a crucial role in establishing the diagnosis, underscoring the importance of considering fungal infections in atypical cutaneous lesions.</p>

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Masked Menace: Primary Cutaneous Aspergillosis Disguised as a Ganglion Cyst in an Immunocompetent Rheumatoid Arthritis Patient

  • 期刊论文

  • 发表日期：

    2026年3月25日

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  • Reshmi Sultana,
  • Akula Nynasindhu,
  • Tushar M. Parmeshwar,
  • Gunvanti Rathod

摘要

Primary cutaneous aspergillosis (PCA) is a rare fungal infection that primarily affects immunocompromised individuals but can occasionally occur in healthy people through traumatic inoculation or surgical wounds. The clinical manifestations vary depending on the host’s immune status, often mimicking conditions like ganglion cysts or abscesses, making early diagnosis challenging. In this case, a 47-year-old female presented with a cystic swelling on her right hand, initially suspected to be a ganglion cyst based on imaging. However, accompanying joint deformities, brittle nails, and raised inflammatory markers raised concerns about underlying rheumatoid arthritis. Histopathological examination post-excision confirmed the presence of necrotizing granulomatous inflammation of fungal origin, identifying Aspergillus species. This case highlights the diagnostic difficulty in differentiating PCA from other cystic lesions, especially in immunocompetent individuals with underlying conditions. Although rheumatoid arthritis does not inherently cause systemic immunosuppression, previously undiagnosed RA may predispose patients to infection. The chronic autoimmune inflammation and resultant local tissue vulnerability weaken host defenses, thereby facilitating opportunistic infection. Histopathology played a crucial role in establishing the diagnosis, underscoring the importance of considering fungal infections in atypical cutaneous lesions.