Ewha Med J.  2016 Jan;39(1):10-13. 10.12771/emj.2016.39.1.10.

Cutaneous Mucormycosis in a Patient with Diabetes Mellitus

• Park JH
• Park SH
• Kang EG
• Kyung GC
• An HD
• An SY

• KMID: 2152751
• DOI: http://doi.org/10.12771/emj.2016.39.1.10

Abstract

Mucormycosis is a rare disease caused by fungi. Most commonly involved sites of mucormycosis infection are sinuses, lungs, skin and soft tissues. Systemic risk factors for mucormycosis are diabetes mellitus, neutropenia, corticosteroid use, hematological malignancies, organ transplantation, metabolic acidosis, deferoxamine use and advanced age. Local risk factors are history of trauma, burns, surgery and motor vehicle accidents. We present a case of cutaneous mucormycosis in a patient with diabetes mellitus. A 66-year-old female with uncontrolled diabetes mellitus, admitted with necrotizing lesion after minor abrasions on leg. We took a culture of the lesion and it is diagnosed with mucormycosis. Disease progressed despite administration of systemic amphotericin B. We performed above-knee amputation and changed antifungal agents into liposomal amphotericin B. A tissue biopsy showed nonseptate, irregularly wide fungal hyphae with frequent right-angle branching. Our case report suggests that patients with risk factors should be observed carefully.

Keyword

Mucormycosis; Diabetes mellitus; Trauma; Amputation; Liposomal amphotericin B

MeSH Terms

Acidosis
Aged
Amphotericin B
Amputation
Antifungal Agents
Biopsy
Burns
Deferoxamine
Diabetes Mellitus*
Female
Fungi
Hematologic Neoplasms
Humans
Hyphae
Leg
Lung
Motor Vehicles
Mucormycosis*
Neutropenia
Organ Transplantation
Rare Diseases
Risk Factors
Skin
Transplants
Amphotericin B
Antifungal Agents
Deferoxamine

Figure

• 

  Fig. 1 (A) A photograph of the right shin. The tibia is exposed on the front of the right shin accompanying necrotizing tibialis anterior muscle. (B) The picture of the wound during debridement before the surgery. Portions of tibia, tibialis anterior muscle and gastrocnemius muscle are seen. Portions of peroneal longus muscle and soleus muscle are demonstrated, as well.

• 

  Fig. 2 Rhizopus spp. was found and identified in the experiment cultivating Rhizopus hyphae in pus with debridement which cultivated no septum. It formed a root-shaped hyphae (rhizoid; closed arrow) and an unbranched sporangiospore shaped object (open arrow) at the joining part between the stolon and sporangiospore.

• 

  Fig. 3 Many zygomycetes (nonseptate, irregularly wide fungal hyphae with frequent right-angle branching; closed arrow) invaded the blood vessel wall (H&E, ×400).

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