Atypical Cause of Forearm Skin Ulceration in a Leukaemic Child: Mucormycosis. A Case Report

Zirak, Christophe; Brutus, Jean-Paul; Mey, Albert De

doi:10.1080/00015458.2005.11681154

Cited by 17 publications

(13 citation statements)

References 5 publications

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“…1,3,4 Surgical debridement of all gangrenous tissue must be performed until healthy tissue is observed, and this may require several operations; however, complete surgical debridement sometimes may not be feasible because of the anatomic structures involved. 2,12 Despite treatment, the frequency of mortality from mucormycosis may be 60%. 1,4,6 In 1 study of 16 transplant patients who had mucormycosis, 10 patients (63%) survived after treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Early diagnosis and treatment of mucormycosis is important for preventing morbidity and mortality. 2 The best diagnostic methods include tissue biopsy for direct smear and fungal culture. 1 Histopathologic examination may show ribbonlike, wide, thick hyphae with right angle branches and no septation.…”

Section: Discussionmentioning

confidence: 99%

“…Other histopathologic findings include vascular invasion, thrombosis, infarction, and hemorrhage. 1,2,4,5 Treatment of mucormycosis includes minimizing immunosuppressive drugs, correcting metabolic disorders, performing radical surgical debridement, and giving systemic antifungal drugs. Amphotericin B is the best antifungal drug, but some azoles such as posaconazole may have efficacy against Mucorales.…”

Section: Discussionmentioning

confidence: 99%

“…7 The differential diagnosis of cutaneous mucormycosis includes ecthyma gangrenosum, pyoderma gangrenosum, vasculitis, and other fungal infections such as aspergillosis, histoplasmosis, and cryptococcosis. 2 We treated a patient who died because of cutaneous mucormycosis after kidney transplant. The purpose of this report is to describe the clinical course of this patient and increase awareness about the possibility of this infection in patients after kidney transplant.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5] These grow rapidly and produce airborne spores. 6 These spores are ubiquitous and commonly grow in the soil, animal waste, vegetables, fruits, and breads.…”

Section: Introductionmentioning

confidence: 99%

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Davuodi

Manshadi²,

Salehi³

et al. 2015

Exp Clin Transplant

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Mucormycosis is an uncommon opportunistic infection that is caused by Mucorales from the Zygomycetes class. Patients with severe immunodeficiency admitted to the hospital are at greatest risk for developing this infection. Mucormycosis usually is transmitted in humans by inhalation or inoculation of spores in the skin or mucous membranes.A 66-year-old man developed a surgical wound infection at 1 week after kidney transplant that did not improve despite broad-spectrum antibiotics and debridement. He was transferred to our hospital 45 days after transplant and had fever and a large purulent wound that was surrounded by a black necrotizing margin. Immunosuppressive drugs were discontinued and the dosage of prednisolone was decreased. Massive debridement was performed but was incomplete because he had full-thickness abdominal wall necrosis. Histopathology showed broad fungal hyphae without septation, consistent with the diagnosis of mucormycosis. Despite antifungal therapy with amphotericin B and additional debridement, the patient died of septic shock at 52 days after kidney transplant.Cutaneous fungal infections should be considered in the differential diagnosis of any nonhealing infected wound that does not respond to broadspectrum antibiotics, especially in patients with predisposing risk factors such as transplant.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5] These grow rapidly and produce airborne spores. 6 These spores are ubiquitous and commonly grow in the soil, animal waste, vegetables, fruits, and breads.…”

Section: Introductionmentioning

confidence: 99%

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Untitled

Davuodi

Manshadi²,

Salehi³

et al. 2015

Exp Clin Transplant

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Chronic, Painful, Nonhealing Ulcer on the Right Arm Following Minor Trauma

2015

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Mucor causing nonhealing skin ulcer diagnosed by scrape cytology: Description of unusual presentation

Ilyas

Al-Abbadi

Raval

et al. 2010

Diagnostic Cytopathology

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Scrape cytology is a simple, rapid, accurate, and an inexpensive adjunctive cytodiagnostic technique that can be very helpful in the clinical diagnostic arena. In this short communication, we report a case of one of our patients where bed-site scrape cytology unveiled mucor fungi as the causative agent for a nonhealing hand ulcer.A 54-year-old Caucasian male developed Acute Myeloid Leukemia on the heels of myelodysplatic syndrome presented at our hospital with worsening shortness of breath. On imaging multiple bilateral pulmonary nodules were seen. He also had a past medical history significant for urothelial carcinoma. Sputum cultures grew Enterococcus Faecalis, group D but no viral or fungal pathogens were detected. He developed an aggressively progressing, painful nontraumatic ulceration on the right hand that was unresponsive to local antibiotic creams and frequent cleaning (Fig. 1). It was initially felt that the ulcer may be leukemic in nature, therefore, we were consulted to perform cytological examination by either scrape cytology or fine needle aspiration of ulcer edges. Scrape cytology was performed using a gentle blade and immediate evaluation was done by Diff Quik stain. The smears revealed multiple nonseptate fungal hyphae with variable width and occasionally branching at wide angles, morphologically consistent with Mucorales family (Fig. 2). The background contained abundant acute and chronic inflammatory cells with degenerate squamous cells. Thorough search for malignant cells was performed and was negative. Culture was also taken from the ulcer bed and revealed Mucor species.The Lactophenol cotton blue staining was done which shows mature globose sporangium with sporangiophores (Fig. 3). This diagnosis facilitated rapid institution of systemic antifungal treatment on the assumption that some of the previously described lung nodules were probably fungal in origin. The patient continued to remain stable for a couple of weeks, but ultimately succumbed to his illness and died.Mucor is a filamentous fungus found in soil, plants, decaying fruits, and vegetables. As well as being ubiquitous in nature and a common laboratory contaminant, Mucor species may cause infections in man, particularly those with compromised immune system. Most of the Mucor species grow rapidly at 25-308C but not at 378C. The strains isolated from human infections are usually one of the few thermotolerant species. 1 Mucor infections frequently involve the sinuses, brain, or lungs. While upper aerodigestive and cerebral mucormycosis are the most common types of the disease, this infection can also manifest in the gastrointestinal tract, skin, and in other organ systems. 2 The presence of mucor in cutaneous ulcers have been rarely reported in the English language literature. The previous reports of Mucor in nonhealing ulcers were described where the diagnosis was established by histological tissue examination in conjunction with culture. 3-6 Up to our knowledge, this is the first case report in the English literature where the diagno...

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Atypical Cause of Forearm Skin Ulceration in a Leukaemic Child: Mucormycosis. A Case Report

Cited by 17 publications

References 5 publications

Untitled

Untitled

Chronic, Painful, Nonhealing Ulcer on the Right Arm Following Minor Trauma

Mucor causing nonhealing skin ulcer diagnosed by scrape cytology: Description of unusual presentation

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