Disseminated infection caused by the fungus Aspergillus fumigatus manifested as extensive skeletal muscle abscesses in a 54-year-old martial artist who presented without previously recognized immunodeficiency, according to a case report published in BMC Pulmonary Medicine. The clinical team documented that while invasive aspergillosis primarily occurs in immunocompromised individuals, skeletal muscle involvement represents an exceptionally uncommon presentation of the disease, with only nine such cases recorded in medical literature since the year 2000.
Before presenting to the hospital, the patient experienced a one-year medical history marked by recurrent soft-tissue abscesses across multiple anatomical locations. These lesions had persisted despite repeated surgical drainage and prolonged courses of antibacterial therapy. On hospital admission, physical examination revealed that the patient was cachectic and had developed multiple fluctuant subcutaneous and intramuscular abscesses, accompanied by marked systemic inflammation evidenced by a C-reactive protein measurement of 180.2 mg/L alongside anemia.
Diagnostic imaging using chest and abdominopelvic computed tomography revealed extensive abscesses located within the chest wall and bilateral iliopsoas muscles. The radiological assessment also identified a cavitary lesion situated in the right middle lobe of the lung that extended directly into the adjacent chest wall and was associated with rib destruction.
Microbiological evaluations established the fungal etiology of the lesions after antibacterial interventions had failed. Computed tomography-guided aspiration of the right iliopsoas abscess demonstrated septate fungal hyphae upon microscopic inspection, while fungal culture and multiplex polymerase chain reaction confirmed the presence of Aspergillus fumigatus. Fungal cultures recovered from purulent drainage of the right chest wall abscess independently yielded positive growth for the identical pathogen.
Antifungal susceptibility testing performed via Etest provided specific minimum inhibitory concentration profiles for the isolated strain. The testing demonstrated minimum inhibitory concentrations of 0.25 mg/L for voriconazole, 0.25 mg/L for isavuconazole, and 0.5 mg/L for amphotericin B. In contrast, higher minimum inhibitory concentrations of 2.0 mg/L for posaconazole and 4.0 mg/L for itraconazole were observed during susceptibility profiling.
Clinical management required combined medical therapy and invasive source control, utilizing intravenous amphotericin B lipid complex alongside oral voriconazole, combined with computed tomography-guided drainage of the right iliopsoas abscess and repeated surgical debridement of right chest wall and thigh abscesses. Routine evaluations revealed no malignancy or previously recognized immunodeficiency, though clinicians noted that comprehensive immunologic testing for underlying host defense defects was not conducted. The patient improved and was discharged after 52 days of hospitalization, with the authors concluding that invasive aspergillosis should be considered when multifocal abscesses fail to respond to antibacterial treatments.
Subject of Research: Disseminated invasive aspergillosis presenting with extensive skeletal muscle abscesses
Article Title: Invasive aspergillosis with disseminated skeletal muscle abscesses in a patient without previously recognized immunodeficiency: a case report and literature review
Article References: Nguyen-Dang, K., Dau-Nguyen, A.-T., Nguyen-Quang, T., Duong-Minh, N., Tran-Ngoc, N., Dang-Vu, T., Lam-Quoc, D., & Truong-Thien, P. (2026). Invasive aspergillosis with disseminated skeletal muscle abscesses in a patient without previously recognized immunodeficiency: a case report and literature review. BMC Pulmonary Medicine. https://doi.org/10.1186/s12890-026-04879-8
Image Credits: AI Generated
DOI: 10.1186/s12890-026-04879-8
Keywords: Invasive aspergillosis, Aspergillus fumigatus, Skeletal muscle abscesses, Iliopsoas abscess, Chest wall abscess, Amphotericin B, Voriconazole, Antifungal susceptibility, Minimum inhibitory concentration, C-reactive protein, Polymerase chain reaction, Computed tomography, Surgical debridement, Immunologic testing, Pulmonary cavitation, Rib destruction, Isavuconazole
Tags: amphotericin Bantifungal susceptibilityAspergillus fumigatusC-reactive proteinChest wall abscesscomputed tomographyiliopsoas abscessImmunologic testinginvasive aspergillosisisavuconazoleminimum inhibitory concentrationpolymerase chain reactionPulmonary cavitationRib destructionSkeletal muscle abscessessurgical debridementvoriconazole
