Nidae Mimouni, Jinane Bari, Siham Karrati, Imane El Khannouri, Awatif El Hakkouni
Primary cutaneous aspergillosis (PCA) is an uncommon mycosis resulting from direct inoculation of Aspergillus into the skin. We report the case of a 33-year-old woman with acute myeloid leukemia (AML) who developed a rapidly progressive paranasal erythematous lesion after induction chemotherapy, febrile neutropenia, and anterior nasal packing for epistaxis. Despite broad-spectrum antibiotics, the lesion evolved into a violaceous necrotic plaque with facial cellulitis and nasal obstruction. Direct microscopy showed hyaline septate hyphae with acute-angle branching and culture identified Aspergillus flavus. Histopathology confirmed tissue invasion by fungal elements. The patient improved after voriconazole therapy following neutrophil recovery, with complete clinical healing. This case shows that early mycological diagnosis and rapid antifungal therapy are essential in immunocompromised patients with necrotic skin lesions.