Case Report
Cutaneous mucormycosis: report of five cases and review of the literature

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Summary

Mucormycosis is a highly aggressive fungal infection caused by Zygomycetes, from the order of Mucorales. This infection commonly presents an aggressive and rapid course and typically affects immunocompromised patients. Mucormycosis can manifest in different clinical patterns and locations. Although the correct diagnosis is often difficult, an early identification is essential for patient survival. Several clinical forms of mucormycosis are recognised. Cutaneous mucormycosis is less common than other clinical forms, but potentially lethal if treatment is not rapid. Tissue examination by histopathology and culture confirms the fungal infection. Standard treatment includes antifungal therapies associated with surgical debridement. We report five different cases of cutaneous mucormycosis treated in our institution and the management carried out in each case.

Section snippets

Case 1

A 72-year-old male farmer was admitted to our hospital. He had a previous history of diabetes type II under insulin therapy, prostatic adenocarcinoma treated with radiotherapy, a hypertensive cardiomyopathy, a left nephrectomy with chronic renal insufficiency and, 10 months before, he had been diagnosed with mielodysplastic syndrome RAEB-I, and was treated with corticoids and immunosuppressive drugs (prednisone and alkylatin agents as melphalan).

At the moment of admission to hospital, he

Discussion

Mucormycosis is an uncommon and aggresive fungal infection caused by Mucorales, fungi of the class Zygomycetes, which is seldom seen in immunocompetent individuals (Table 1). Nowadays it is getting more frequent due to the increasing number of immunocompromised patients.14, 15, 16 Mucormycosis may manifest in different patterns and locations (rhinocerebral, pulmonary, cutaneous, gastrointestinal, cardiac and other rare forms). Disseminated zygomycosis has a high mortality rate and a dreadful

References (56)

  • C.F. Carpenter et al.

    Images in clinical medicine. Cutaneous zygomycosis (mucormycosis)

    N Engl J Med

    (1999 Dec16)
  • A.M. Sugar

    Agents of mucormycosis and related species

  • A. Chakrabarti et al.

    Primary cutaneous zygomycosis due to Saksenaea vasiformis, and Apophysomyces elegans

    Clin Infect Dis

    (1997)
  • N. Faisal et al.

    Successful treatment of a child with posttraumatic necrotizing fasciitis caused by Apophysomyces elegans: case report and review of literature

    Pediatr Infect Dis J

    (2004)
  • R.D. Adam et al.

    Mucormycosis: emerging prominence of cutaneous infections

    Clin Infect Dis

    (1994)
  • R. Herbrecht et al.

    Treatment of 21 cases of invasive mucormycosis with amphotericin B colloidal dispersion

    Eur J Clin Microbiol Infect Dis

    (2001)
  • M. Kobayashi et al.

    Cutaneous zygomycosis: a case report and review of Japanese reports

    Mycoses

    (2001)
  • T.T. Ng et al.

    Successful treatment of sinusitis caused by Cunninghamella bertholletiae

    Clin Infect Dis

    (1994)
  • M. Chayakulkeeree et al.

    Zygomycosis: the re-emerging fungal infection

    Eur J Clin Microbiol Infect Dis

    (2006 Apr)
  • P. Lenane et al.

    Mucormycosis infection presenting as a non-healing ulcer in an immunocompromised patient

    Clin Exp Dermatol

    (2003)
  • C.A. Kauffman

    Zygomicosis: reemergence of an old pathogen

    Clin Infect Dis

    (2004 Aug15)
  • B. Yesidia et al.

    Hyperbaric oxygen therapy for cutaneous/ Soft-tissue zygomycosis complicating diabetes mellitus

    Plast Reconstr Surg

    (1998)
  • C. Jimenez et al.

    Successful treatment of mucor infection after liver or pancreas-kidney transplantation

    Transplantation

    (2002)
  • J.E. Losee et al.

    Primary cutaneous mucormycosis: guide to surgical management

    Ann Plast Surg

    (2002)
  • P. Venkatesan et al.

    Evaluation and management of fungal infections in immunocompromised patients

    Dermatol Therapy

    (2005)
  • D.E. Weng et al.

    Successful medical management of isolated renal zygomycosis: case report and review

    Clin Infect Dis

    (1998)
  • S. Vigouroux et al.

    Zygomycosis after prolonged use of voriconazole in immunocompromised patients with hematologic disease: attention required

    Clin Infect Dis

    (2005 Feb15)
  • P.C. Molan

    Clinical usage of honey as a wound dressing: an update

    J Wound Care

    (2004)
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