{'fraction_non_alphanumeric': 0.028876582278481014, 'fraction_numerical': 0.014240506329113924, 'mean_word_length': 5.3542713567839195, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
HICKMAN CATHETER‐ASSOCIATED PRIMARY CUTANEOUS ASPERGILLOSIS IN A PATIENT WITH THE ACQUIRED IMMUNODEFICIENCY SYNDROME

A 37-year-old white man with acquired immunodeficiency syndrome (AIDS) presented with a 3-day history of fever, pain, and erythema around a left subclavian Hickman catheter that had been placed 4 months earlier for hyperalimentation because of intractable nausea, vomiting, and diarrhea from gastrointestinal cryptosporidiosis. The patient had experienced two previous localized line-infections of this catheter (caused by Enterobacter and Staptiylococcus aureus), and had recently completed a course of vancomycin for the latter. His medical history included recurrent perirectal herpes simplex and oral hairy leukoplakia. The most recent CD4 count, 4 months earlier, was 67 x 10̂ per liter. Medications included ondansetron, paromomycin sulfate, monthly aerosolized pentamidine, and fentanyl patches. On admission, the patient exhibited erythema, warmth, and induration of the left chest around the Hickman catheter, without evidence of discharge. A verrucous plaque was noted incidentally several centimeters below the catheter. The catheter was removed, an associated tract abscess was incised, drained, and cultured, and the patient was started on intravenous vancomycin and ceftazidime. Cefazolin was substituted for the latter, after the abscess culture grew Staphylococcus aureus sensitive to cefazolin. Blood cultures remained negative and a sputum culture grew Candida. A chest film was clear and a white blood cell count was 3.2 x 10̂ per liter with the following differential: .76 neutrophils, .07 bands, .12 lymphocytes, and .05 monocytes. Electrolytes and liver function tests were normal. The dermatology service was consulted on the 2nd hospital day to evaluate an erythematous plaque on the left chest wall. The plaque was asymptomatic and had been slowly growing for several months. Physical examination revealed a 1.8 X 2.0 cm verrucous plaque with scattered micropustules (Fig. 1) located 4 cm inferior to the previous Hickman catheter site. There was no associated lymphadenopathy. A punch biopsy revealed ulceration, acute and chronic dermal inflammation, and microabscess formation with septate hyphae branching at 45 degree angles (Fig. 2). Fungal culture yielded organisms identified as aspergillus fumigatus. Special stains and cultures were negative for other organisms. Therapy with intravenous amphotericin B was started at a dose of 0.6 mg/kg/day (30 mg) and the left chest plaque