Primary Cutaneous Aspergillosis Due to Aspergillus flavus in an Immunocompetent Patient

Invasive aspergillosis is a life-threatening infection caused by <i>Aspergillus</i> species, affecting the lungs, central nervous system, nasal and orbital regions, and skin. Primary cutaneous aspergillosis (PCA) occurs through direct skin inoculation via trauma, burns, or surgical wounds, with <i>Aspergillus fumigatus, Aspergillus flavus</i>, and <i>Aspergillus niger</i> as common causative species, and is rare in immunocompetent individuals. We report a case of PCA in a 56-year-old immunocompetent patient with facial and right ankle ulcers, persisting for two years. The patient had no history of diabetes, corticosteroid use, or immunodeficiency. Fungal culture and metagenomic next-generation sequencing (mNGS) confirmed <i>A. flavus</i> infection. Voriconazole therapy, surgical debridement, and specialized wound care led to the gradual healing of the ulcers. This case highlights the importance of early diagnosis and intervention to prevent infection spread and progression to systemic aspergillosis or septic shock.