• Contact us
  • E-Submission

Ewha Med J : The Ewha Medical Journal

OPEN ACCESS
mobile search button mobile menu button
Search
Advanced Search
ABOUT
BROWSE ARTICLES
JOURNAL POLICIES
FOR CONTRIBUTORS

Articles

Page Path

Case Report

Cutaneous Mucormycosis in a Patient with Diabetes Mellitus

Ji Hwan Park, Seo Hwa Park, Eun Gyu Kang, Gyu Cheon Kyung, Hyo Dong An, So-Yeon An
The Ewha Medical Journal 2016;39(1):10-13. Published online: January 29, 2016

Department of Internal Medicine, Hongik Hospital, Seoul, Korea.

Corresponding author So-Yeon An. Department of Internal Medicine, Hongik Hospital, 225, Mokdong-ro, Yangcheon-gu, Seoul 07937, Korea. Tel: 82-2-2600-0437, Fax: 82-2-2697-4605, yeonigge00@naver.com
• Received: September 23, 2015   • Accepted: October 29, 2015

Copyright © 2016, The Ewha Medical Journal

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

  • 60 Views
  • 0 Download
  • 1 Crossref
prev next

Full Article

Download PDF Download PDF
  • 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.
  • Keywords: Mucormycosis; Diabetes mellitus; Trauma; Amputation; Liposomal amphotericin B
  • 1. Camara-Lemarroy CR, Gonzalez-Moreno EI, Rodriguez-Gutierrez R, Rendon-Ramirez EJ, Ayala-Cortes AS, Fraga-Hernandez ML, et al. Clinical features and outcome of mucormycosis. Interdiscip Perspect Infect Dis 2014;2014:562610.
  • 2. Mantadakis E, Samonis G. Clinical presentation of zygomycosis. Clin Microbiol Infect 2009;15:Suppl 5. 15-20.
  • 3. Ingram PR, Suthananthan AE, Rajan R, Pryce TM, Sieunarine K, Gardam DJ, et al. Cutaneous mucormycosis and motor vehicle accidents: findings from an Australian case series. Med Mycol 2014;52:819-825.
  • 4. Zaman K, Kaur H, Rudramurthy SM, Singh M, Parashar A, Chakrabarti A. Cutaneous mucormycosis of scalp and eyelids in a child with type I diabetes mellitus. Indian J Dermatol Venereol Leprol 2015;81:275-278.
  • 5. Roden MM, Zaoutis TE, Buchanan WL, Knudsen TA, Sarkisova TA, Schaufele RL, et al. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis 2005;41:634-653.
  • 6. Petrikkos G, Skiada A, Lortholary O, Roilides E, Walsh TJ, Kontoyiannis DP. Epidemiology and clinical manifestations of mucormycosis. Clin Infect Dis 2012;54:Suppl 1. S23-S34.
  • 7. Ribes JA, Vanover-Sams CL, Baker DJ. Zygomycetes in human disease. Clin Microbiol Rev 2000;13:236-301.
  • 8. Iida T, Sawada N, Takahashi M, Zendejas IR, Kayler LK, Magliocca JF, et al. Successful treatment of invasive mucormycosis in a liver transplant patient by arm amputation. Transplant Proc 2010;42:2794-2796.
  • 9. Su WP, Davis MD, Weenig RH, Powell FC, Perry HO. Pyoderma gangrenosum: clinicopathologic correlation and proposed diagnostic criteria. Int J Dermatol 2004;43:790-800.
  • 10. Kerr OA, Bong C, Wallis C, Tidman MJ. Primary cutaneous mucormycosis masquerading as pyoderma gangrenosum. Br J Dermatol 2004;150:1212-1213.
  • 11. Geller JD, Peters MS, Su WP. Cutaneous mucormycosis resembling superficial granulomatous pyoderma in an immunocompetent host. J Am Acad Dermatol 1993;29:462-465.
  • 12. Luo Y, Zeng F, Huang X, Li Q, Tan G, Xi L, et al. Successful treatment of a necrotizing fasciitis patient caused by Mucor indicus with amphotericin B and skin grafting. Mycopathologia 2014;177:187-192.
  • 13. de Oliveira-Neto MP, Da Silva M, Fialho Monteiro PC, Lazera M, de Almeida Paes R, Novellino AB, et al. Cutaneous mucormycosis in a young, immunocompetent girl. Med Mycol 2006;44:567-570.
  • 14. Cornely OA, Arikan-Akdagli S, Dannaoui E, Groll AH, Lagrou K, Chakrabarti A, et al. ESCMID and ECMM joint clinical guidelines for the diagnosis and management of mucormycosis 2013. Clin Microbiol Infect 2014;20:Suppl 3. 5-26.
  • 15. Ahmadinejad Z, Khazraiyan H, Ghanbari F, Ahmadi B, Gerami Shoar M. Cutaneous Mucormycosis in a Diabetic Patient following Traditional Dressing. Case Rep Dermatol Med 2013;2013:894927.
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.

emj-39-10-g001.jpg
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.

emj-39-10-g002.jpg
Fig. 3

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

emj-39-10-g003.jpg

Figure & Data

References

    Citations

    Citations to this article as recorded by  
    • Epidemiology and Treatment Outcome of Mucormycosis in Khuzestan, Southwest of Iran
      Roohangiz Nashibi, Sara Afzalzadeh, Mohammad Javad Mohammadi, Ahmad Reza Yari, Farid Yousefi
      Archives of Clinical Infectious Diseases.2016;[Epub]     CrossRef

    Download Citation

    Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.

    Format:

    Include:

    Cutaneous Mucormycosis in a Patient with Diabetes Mellitus
    Ewha Med J. 2016;39(1):10-13.   Published online January 29, 2016
    DOI: https://doi.org/10.12771/emj.2016.39.1.10
    Download Citation
    Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.
    Format:
    • RIS — For EndNote, ProCite, RefWorks, and most other reference management software
    • BibTeX — For JabRef, BibDesk, and other BibTeX-specific software
    Include:
    • Citation for the content below
    Cutaneous Mucormycosis in a Patient with Diabetes Mellitus
    Ewha Med J. 2016;39(1):10-13.   Published online January 29, 2016
    DOI: https://doi.org/10.12771/emj.2016.39.1.10
    Close

    Figure

    • 0
    • 1
    • 2
    Cutaneous Mucormycosis in a Patient with Diabetes Mellitus
    Image Image Image
    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).

    Fig. 1

    Fig. 2

    Fig. 3

    Cutaneous Mucormycosis in a Patient with Diabetes Mellitus
    Ewha Med J : The Ewha Medical Journal

    ABOUT

    BROWSE ARTICLES 

    JOURNAL POLICIES

    FOR CONTRIBUTORS 

    © Ewha Womans University College of Medicine.
    TOP