# First Case of Cutaneous Coinfection with Aspergillus flavus and Klebsiella pneumoniae: Case Report and Literature Review

## TL;DR

A woman developed a rare skin infection with two pathogens, Aspergillus flavus and Klebsiella pneumoniae, after severe sepsis, requiring aggressive treatment.

## Contribution

First reported case of cutaneous coinfection with Aspergillus flavus and Klebsiella pneumoniae.

## Key findings

- The patient had concurrent cutaneous A. flavus and XDR K. pneumoniae infection after septic shock.
- Histopathology and MALDI-TOF confirmed the dual infection, with A. flavus only susceptible to azoles.
- Despite targeted therapy, the infection progressed, necessitating bilateral mastectomy.

## Abstract

Background and Clinical Significance: Cutaneous aspergillosis caused by Aspergillus flavus is rare and coinfection with Klebsiella pneumoniae was reported only in pulmonary disease. Case Presentation: We describe a 57-year-old woman with no prior comorbidities who developed septic shock requiring intensive care, broad-spectrum antibiotics, corticosteroids, and renal replacement therapy. Six days after discharge, she was readmitted with fever, leukopenia, thrombocytopenia, cavitary lung lesions, and multiple erythematous nodules on the limbs and mammary regions. Bronchial aspirate cultures detected K. pneumoniae, while progressive cutaneous lesions required surgical debridement. Histopathology revealed angioinvasive septate hyphae, and MALDI-TOF identified A. flavus. The K. pneumoniae strain was extensively drug resistant; A. flavus was susceptible only to azoles. Despite targeted therapy, lesions progressed requiring bilateral mastectomy. Conclusions: This case illustrates a previously unreported scenario in which secondary immunosuppression after severe sepsis led to concurrent cutaneous A. flavus infection and extensively drug-resistant (XDR) K. pneumoniae. Early recognition of mixed fungal–bacterial infections is essential for appropriate management.