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At all levels of the dermis, there were dilated blood vessels that were engorged with erythrocytes (Figure 2). Areas of necrosis were present in the overlying epidermis. In the interstitial dermis, there was a sparse infiltrate composed of mononuclear cells associated with hemorrhage. On hematoxylin-eosin staining, mycelia were identified within the lumina and infiltrating the walls of vessels near the dermal-subcutaneous border (Figure 3). Gomori methenamine silver–stained sections revealed abundant mycelial forms throughout the dermis and subcutis (Figure 4). The hyphae were septate, measuring 3 to 5 μm in width, with dichotomous, acute-angle branching. A preliminary diagnosis of angioinvasive aspergillosis was made. Amphotericin B therapy was initiated, but the patient died of multiorgan failure due to presumed fungal sepsis 1 day later. Culture of the skin biopsy specimen later yielded Aspergillus flavus.
Dehisced Wound in a Heart Transplant Recipient—Diagnosis. Arch Dermatol. 2005;141(8):1035-1040. doi:10.1001/archderm.141.8.1035-h