Primary Cutaneous Aspergillosis in Four Extremely Low Birthweight Neonates: A Rare Cluster of Cases in A Tertiary Arizona NICU

Backieword JSD, Zoellner T, Mecheill CB and Cietch J

Published on: 2026-02-05

Abstract

Background: Primary cutaneous aspergillosis (PCA) is a rare fungal infection predominantly affecting immune compromised individuals, including preterm and term neonates. A comprehensive review of the literature from 1991 to 2023 identified 37 well-documented case reports of neonatal PCA. To our knowledge, this report presents the first documented cluster of cases of neonatal PCA in Arizona and describes one of the largest known clusters of cases in the United States.

Case Description: Over the span of approximately 21 weeks, four preterm infants in the Valleywise Hospital Neonatal Intensive Care Unit (NICU) in Phoenix, AZ, developed diffuse cutaneous lesions later confirmed to be Aspergillus. All were treated with antifungal medications and none survived.

Conclusion: While the deaths of all four neonates were secondary to complications of extreme prematurity, the extent to which PCA infection contributed to their eventual demise is unclear. The source of fungal exposure is unknown, but we explore potential etiologies based on existing literature. Additionally, this report details the clinical presentation, diagnostic workup, and pharmacologic management of each case, contributing valuable insight into this rare infection that often carries high mortality risk.