Primary cutaneous mucormycosis (zygomycosis) caused by <i>Apophysomyces elegans</i>

Abstract

A 53 year-old male diabetic presented with a month-old, painful ulcer with necrotic margins over the right thigh. Wound debridement was done twice and the ulcer showed recurrent growth of a white, cottony filamentous structure. Cutaneous mucormycosis was suspected and confirmed by histopathology and a culture isolate of Apophysomyces elegans . The patient was treated with liposomal amphotericin-B and itraconazole followed by partial thickness skin grafting, and then discharged after being prescribed posaconazole syrup for three weeks. Regular follow-up was done and during the last visit after six months following discharge, the ulcer was found to have healed well with no recurrence of the fungus.

Changing epidemiology of an emerging infection: zygomycosis

“…A few years later, this pathogen was found in a clinical case with a trauma injury and was also cultured from environmental samples [16]. Infections with Apophysomyces are mostly acquired in tropical and subtropical areas, and cases have been described from several states in the USA (Texas [17–21], Arizona [22–25], Florida [26,27], Mississippi [28], Oklahoma [29], Georgia [30] Minnesota [31], Alabama [32], South Carolina [33]), different regions in India [34–45], Venezuela [46], Colombia [47], Mexico [20,48], Australia [16], Saudi Arabia [49], and Kuwait [50]. A case described from The Netherlands was linked to a subtropical source in the Caribbean [51].…”

Mucormycosis Caused by Unusual Mucormycetes, Non-Rhizopus, -Mucor, and -Lichtheimia Species

“…A chronic soft tissue Apophysomyces elegans infection was reported for a diabetic patient who was in an automobile accident but did not have a penetrating injury (275). A painful cutaneous ulcer subsequently developed in the patient.…”

“…One month later, erythematous, indurated swelling occurred, resulting in a blister, a thick hemorrhagic crust, and surrounding necrotic tissue with regional lymphadenopathy. After excision of this lesion, the infection evolved into a necrotizing infection that extended to the quadriceps muscle, requiring radical debridement (275).…”

“…A lack of awareness about fungal infections in most centers in developing countries probably contributes to underestimation of its importance (55). The most common underlying immunosuppressive conditions predisposing patients to Apophysomyces elegans infections include diabetes mellitus (36,55,56,64,99,116,158,187,190,221,246,275,363), organ transplantation (8,221), alcoholic cirrhosis (157,355), and idiopathic myelofibrosis (56).…”

“…Cutaneous infections caused by Apophysomyces elegans are characterized by pain, erythema, and swelling or induration, sometimes with vesicles, pus discharge from an abscess or the sinuses, and formation of an ulcer with various degrees of necrosis (58,70,187,221,275,298,358,363). Fever has been described in several cases (70,170,187,223,358,363).…”