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Methylprednisolone Cutaneous mucormycosis: case reportA 77-year-old woman developed cutaneous mucormycosis during treatment with methylprednisolone [route not stated].The woman presented with gradually progressive asymptomatic multiple erythematous papules and pustules on the left middle finger since 11 months. In 18 th March 2014, she had started steroid therapy for gout. She had been treated with methylprednisolone 60 mg/day followed by a 6 day taper to 10 mg/day then, the baseline dose of methylprednisolone was administered for 2 weeks. Later, she was treated with methylprednisolone 5 mg/day for 2 weeks followed by 2.5 mg/day for 1 month. After 1 month of administration of methylprednisolone, few multiple papules and pustules with surrounding erythema occurred on her left middle finger. Her dermatological examination showed well defined multiple erythematous, hard papules with a central crust, and pustules on the dorsal surface of the finger. Her laboratory investigations revealed haemoglobin of 11.2 g/dL, leukocyte count of 13750 /µL, ALT 72 IU/L, AST 40 IU/L and C-reactive protein 0.60 mg/L. Her Histopathology of the skin biopsy revealed a diffuse inflammatory infiltration and necrosis in the epidermis and deep dermis. High power view of the specimen showed chronic granulomatous inflammation with lymphohistiocytes and multinucleated giant cell in the dermis. Microscopic examination revealed non-septate fungal hyphae with large and long branches oriented at right angles. Later, fungal culture was performed which revealed rapidly growing whitish cottony colonies that turned dark brown at the surface of the plate. On staining, the fungus showed brown coloured rhizoids and unbranched sporangiospores with sporangia on each end. The isolated fungus was identified as belonging to Rhizopus species of class Zygomycetes. Her clinical, histopathological and mycological findings were consistent with the diagnosis of cutaneous mucormycosis.The woman was treated with itraconazole for 2 months. Her lesions improved with residual hyperkeratosis. In a follow-up, she was asymptomatic.Author comment: "In conclusion, this case suggests that treatment with steroids or immunosuppresants can cause deep fungal infection".Noh SH, et al. A case of cutaneous mucormycosis occurring after systemic steroid therapy.
