Images in Clinical Medicine

Cutaneous Zygomycosis (Mucormycosis)

Christopher F. Carpenter, M.D., and Aruna K. Subramanian, M.D.

N Engl J Med 1999; 341:1891December 16, 1999

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Figure 1 A 60-year-old man with diabetes mellitus and advanced cirrhosis underwent orthotopic liver transplantation that was complicated by an intraoperative myocardial infarction. His immunosuppressive regimen included tacrolimus and methylprednisolone, and his postoperative course was complicated by poor graft function with intrahepatic cholestasis, hyperglycemia, and progressive renal failure, as well as vancomycin-resistant Enterococcus faecium bacteremia and Candida parapsilosis fungemia. Laboratory studies revealed persistent leukocytosis with a leftward shift and low serum iron levels. At the end of the first postoperative week, a skin lesion developed above the patient's right eye; the lesion was initially erythematous and subsequently enlarged and became necrotic (Panel A). There was no history of trauma to the area or use of adhesive dressings. Skin biopsy revealed invasive nonseptate hyphal fungal forms consistent with the presence of an agent of zygomycosis (Panel B, calcofluor white, ×40), and a culture grew Rhizopus oryzae. The lesion was excised, split-thickness skin grafting was performed, and systemic amphotericin B was given. Unfortunately, the patient's condition deteriorated, and he died of complications of septic shock one month after transplantation.

Christopher F. Carpenter, M.D.
Aruna K. Subramanian, M.D.
Johns Hopkins University, Baltimore, MD 21287-0003

Citing Articles (8)

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   M.E. Arnáiz-García, D. Alonso-Peña, M. del Carmen González-Vela, J.D. García-Palomo, J.R. Sanz-Giménez-Rico, A.M. Arnáiz-García. (2009) Cutaneous mucormycosis: report of five cases and review of the literature. Journal of Plastic, Reconstructive & Aesthetic Surgery 62:11, e434-e441
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   Mahmoud R. Hussein. (2008) Mucocutaneous Splendore-Hoeppli phenomenon. Journal of Cutaneous Pathology 35:11, 979-988
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   N. G. Almyroudis, D. A. Sutton, P. Linden, M. G. Rinaldi, J. Fung, S. Kusne. (2006) Zygomycosis in Solid Organ Transplant Recipients in a Tertiary Transplant Center and Review of the Literature. American Journal of Transplantation 6:10, 2365-2374
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   M. M. Roden, T. E. Zaoutis, W. L. Buchanan, T. A. Knudsen, T. A. Sarkisova, R. L. Schaufele, M. Sein, T. Sein, C. C. Chiou, J. H. Chu, D. P. Kontoyiannis, T. J. Walsh. (2005) Epidemiology and Outcome of Zygomycosis: A Review of 929 Reported Cases. Clinical Infectious Diseases 41:5, 634-653
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   R. M. Prabhu, R. Patel. (2004) Mucormycosis and entomophthoramycosis: a review of the clinical manifestations, diagnosis and treatment. Clinical Microbiology and Infection 10:s1, 31-47
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   Edmond Schmied, Jean-Franois Dufour, Sylvie Euvrard. (2004) Nontumoral dermatologic problems after liver transplantation. Liver Transplantation 10:3, 331-339
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   Carlos Jim??nez, Carlos Lumbreras, Jos?? Mar??a Aguado, Carmelo Loinaz, Gloria Paseiro, Amado Andr??s, Jos?? Mar??a Morales, Gregorio S??nchez, Ignacio Garc??a, Amalia del Palacio, Enrique Moreno. (2002) SUCCESSFUL TREATMENT OF MUCOR INFECTION AFTER LIVER OR PANCREAS-KIDNEY TRANSPLANTATION. Transplantation 73:3, 476-480
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   Annarosa Virgili, Maria Rosaria Zampino, Lucia Mantovani. (2002) Fungal Skin Infections in Organ Transplant Recipients. American Journal of Clinical Dermatology 3:1, 19-35
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