We describe a case of primary cutaneous mucormycosis (zygomycosis) in a patient with idiopathic aplastic anemia which responded to surgical debridement and therapy with liposomal amphotericin B. The tissue removed at surgery showed dense infiltration with fungal hyphae on histopathological examination. Primary cultures of tissue on solid media were negative, but Absidia corymbifera was isolated from unprocessed tissue placed in brain heart infusion broth. CASE REPORTA nineteen-year-old man with aplastic anemia was referred to a tertiary referral hospital in February 2000. He initially presented to another hospital with a 1-week history of bleeding gums associated with tooth brushing. Pancytopenia was detected on full blood count, and bone marrow examination confirmed bone marrow aplasia. Upon admission to this hospital, he was febrile and pale and had multiple bruises.Broad-spectrum empirical antibacterial therapy with piperacillin-tazobactam and gentamicin was commenced. Because he remained pyrexial, vancomycin and subsequently fluconazole (400 mg daily) were added. On hospital day 4, an area of ecchymoses was noted on the dorsal aspect of the left forearm. The patient had no recollection of preceding trauma at the site of the lesion. The lesion became more extensive and necrotic over 2 days. Empirical therapy with liposomal amphotericin B (3 mg/kg of body weight) was commenced on hospital day 6 based on a clinical suspicion of mold infection, and fluconazole was discontinued at this point. The lesion was immediately and thoroughly debrided. Clinical and radiological assessment, including sinus and chest X ray, revealed no evidence of disease at other sites. Further debridement was performed on hospital day 13, and on day 15, the wound was grafted with skin from the left inner thigh. On day 17, he was transferred to another hospital for HLA-matched bone marrow transplantation. Liposomal amphotericin B was continued until the bone marrow engraftment was confirmed and the forearm lesion was healed. At no point in his clinical course was there clinical or radiological evidence of mucormycosis at any other site. The patient remains well more than 1 year post-bone marrow transplantation.

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