Invasive Aspergillus versicolor infection of the oral and vaginal mucosa in a patient with Lichen planus

Background and Purpose: Invasive aspergillus stomatitis and vaginitis are relatively rare in a patient with Oral Lichen planus and a history of steroid and antibiotic use. Case Presentation: A 49-year-old female diagnosed with lichen planus presented with severe stomatitis and cheilitis and was treated with fluconazole as the clinical appearance resembled thrush. Recurrence of her symptoms despite adequate treatment led to culture from the lesions, which repeatedly grew Aspergillus spp., an unlikely pathogen at this site. Sequencing further identified the isolate as Aspergillus versicolor. Antifungal treatment was initiated, first with micafungin and then with voriconazole. The patient responded and was discharged, only to return with a relapse of symptoms. Environmental samples from her house revealed the same Aspergillus spp. The patient responded to isavuconazole and was discharged home after thorough house decontamination, with no recurrence of lesions on follow-up. Conclusion: Aspergillosis should be considered a differential diagnosis in mucosal lesions that are difficult to treat in both immunocompetent as well as immunocompromised individuals.