Gangrenous Cutaneous Mucormycosis Caused by Rhizopus oryzae: A Case Report and Review of Primary Cutaneous Mucormycosis in China Over Past 20 Years

Abstract

Cutaneous mucormycosis is a rare opportunistic infection caused by zygomycetes that can be rapidly fatal if unrecognized. We describe the clinical, histopathological, fungal and molecular features of a case of gangrenous cutaneous mucormycosis. The patient presented with great necrosis on his right forearm at the site of detained intravenous cannula needle. He had type II diabetes and chronic renal insufficiency. KOH mount of black eschar showed many broad, aseptate fungal hyphae with right-angle branching. PAS staining of the tissue sample revealed similar broad hyphae in the dermis and cutis. Fungal culture and ITS sequence analysis identified this fungus as Rhizopus oryzae. As no organ involvement was detected, the patient was diagnosed with primary cutaneous mucormycosis. Considering the poor state of the patient, complete excision of the infectious tissue was performed without skin graft instead of amputation. At the same time, intravenous liposomal amphotericin B was given, starting from a small dosage and increased to a total dosage amount of 5.45 g. The wound recovered well with granulation. We emphasize that early recognition and prompt therapy including the control of the primary diseases were important. In this article, we also reviewed the features of primary cutaneous mucormycosis reported in China over the last 20 years.

Molecular identification of clinical “difficult-to-identify” microbes from sequencing 16S ribosomal DNA and internal transcribed spacer 2

“…in China. Rhizopus oryzae can cause invasive fungal infections called mucormycosis in humans [34]. Here we report a serious case of disseminated type mucormycosis caused by Rhizopus oryzae in a patient suffering diabetes with orbital cellulitis, which is a rare clinical case.…”

Fungal Infections Complicating Lung Transplantation

“…115 Dissemination is usually fatal. 107,112,115 Based on anatomic localization, mucormycosis can be classified as one of six forms: 110 (1) rhino-orbital-cerebral, 39,124,147 (2) pulmonary, 38,125,136 (3) cutaneous, 170,179,180 (4) gastrointestinal, 181,182 (5) disseminated, 32,38,107,112 and (6) uncommon sites. 110,121,133,134 In a review of 929 cases of mucormycosis, most common sites of involvement were sinuses (39%), pulmonary (24%), skin/soft tissue infection (SSTI) (19%), and disseminated (23%).…”

Cutaneous mucormycosis of scalp and eyelids in a child with type I diabetes mellitus

“…Cutaneous mucormycosis of the head and neck region accounts for 14% of all cases, and scalp involvement has been documented in adults. [6,12] We found one previously reported case of pediatric scalp mucormycosis in a severely dehydrated malnourished child. The lesion began as a black eschar at the site of an intravenous catheter on the scalp.…”

“…[2] However, cutaneous mucormycosis involving other regions like the face, nose, breast, chest, back, abdomen, gluteal area, perineum, and scalp have been reported earlier. [3][4][5][6] We report a case of pediatric primary cutaneous mucormycosis affecting the scalp, forehead, and upper eyelids, which was promptly diagnosed and successfully treated.…”