Copyright © American Burn Association. Unauthorized reproduction of this article is prohibited. 1 Patients with severe burns (>60% of the TBSA) bear a high risk of developing invasive burn wound infec- tions that can lead to generalized sepsis, multiorgan dysfunction, and, eventually, death. According to a recent epidemiological study, sepsis is responsible for 75% of all deaths after burn trauma. 1 Invasive asper- gillosis primarily occurs in the lungs of immunocom- promised patients, from where it may disseminate into other tissues. 2,3 Less commonly, invasive asper- gillosis may be found in mildly immunocompro- mised patients, such as corticosteroid-treated chronic obstructive pulmonary disease patients and surgical patients, including surgically treated burn victims. 4–6 Definitive diagnosis of invasive aspergillosis usually requires both histological evidence and positive cul- tures of Aspergillus fumigatus. 7 The recent advent of galactomannan antigen assay has permitted a more efficient diagnosis of aspergillosis. 7,8 Voriconazole, a second-generation triazole, has greatly improved the treatment of invasive aspergillosis. 3 Owing to its improved efficacy and reduced toxicity, voricon- azole is currently the drug of choice over ampho- tericin B. 3,9,10 Despite recent advances in developing combination antifungal therapies, the survival rates of refractory cases of invasive aspergillosis are quite low. 11 In addition, an increased incidence of fungal infections has been observed among severely burned patients, 12,13 with Aspergillus infections resulting in particularly high morbidity and mortality rates up to 33%. 5,6,14 This increase may be linked to the focused management of bacterial burn wound infections with topical and systemic antibacterial agents. 12,13 Here, we describe the feasibility of treating successfully an invasive A. fumigatus deep-burn wound infection in a patient with 80% full-thickness TBSA burn with a combination of topical terbinafine and systemic vori- conazole administration. Case Report A 33-year-old man weighing 74.8 kg was admit- ted 1 hour after an accidental blast for 92% TBSA (80% full-thickness) burns and inhalation syndrome. On admission, escharotomies were required on the patient’s neck, thorax, abdomen, upper, and lower limbs. Initial resuscitation resulted in acute abdomi- nal compartment syndrome, which required same- day laparotomy. Rhabdomyolysis and acute renal failure, linked to the severity of the shock, necessitated long-lasting continuous renal replacement therapy. After the initial resuscitation phase, hydrotherapy Copyright © 2014 by the American Burn Association 1559-047X/2014 DOI: 10.1097/BCR.0000000000000143 We describe an invasive Aspergillus fumigatus deep-burn wound infection in a severely burned patient that was successfully treated with a combination of topical terbinafine and systemic voriconazole antifungal therapy. To our knowledge, this is the first case report describing the effective control of an invasive deep-burn wound infection using this combination. (J Burn Care Res 2014;XXX:00–00) From the *Service of Pharmacy, ‡Service of Intensive Care Medi- cine, §Service of Plastic and Reconstructive Surgery, ║Institute of Microbiology, ¶Service of Infectious Diseases, and #Service of Pathology, Centre Hospitalier Universitaire Vaudois and Uni- versity of Lausanne, Switzerland; **Centre des Brûlés, Centre Hospitalier St. Joseph et St Luc, Lyon, France; and †School of Pharmaceutical Sciences, University of Geneva, University of Lausanne. Address correspondence to Yok-Ai Que, MD, PhD, Service of Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, BH08-624, 1011, Lausanne, Switzerland. Effective Treatment of Invasive Aspergillus fumigatus Infection Using Combinations of Topical and Systemic Antifungals in a Severely Burned Patient Anne Fournier,*† Olivier Pantet,‡ Samia Guerid,§ Philippe Eggimann,‡ Jean-Luc Pagani,‡ Jean-Pierre Revelly,‡ Philippe M. Hauser,║ Oscar Marchetti,¶ Sara Fontanella,# Igor Letovanec,#, François Ravat,** Mette M. Berger,‡ André Pannatier,† Pierre Voirol,*† Yok-Ai Que, MD, PhD‡ CASE REPORT