Severe Cutaneous Aspergillosis in a Neonate With Extremely Low Birth Weight: A Case Requiring Multiple Surgical Interventions

Fungal infections are associated with high risk of morbidity and mortality in the neonatal population. Infants who are premature and extremely low birth weight (ELBW) are at increased risk for fungal infections due to their fragile skin barrier, immature immune systems, disruption of normal flora with antibiotic exposure, presence of central catheters, and corticosteroid use. In neonates, most invasive fungal infections are caused by the Candida species. Infections from other fungal species, such as Aspergillus , are rare. The case presented in this article describes an infant who is ELBW born at 23 weeks' gestation and their course with severe cutaneous A. fumigatus infection requiring multiple surgical debridement procedures. These fungal infections require a high index of suspicion for prompt identification and early treatment. Primary cutaneous aspergillosis should be suspected in high-risk infants with rapidly progressive ulcerative or necrotic skin lesions. [ Pediatr Ann . 2025;54(4):e130–e134.]