A case of cutaneous mucormycosis in Shanghai, China

Abstract

A 34-year-old female farmer suffered from localized cutaneous mucormycosis for 17 years. At the first admission, the lesion was a dull red plaque, about 7 x 9 cm in size with ulcerations, surrounded by some nodules on the dorsum of her right hand. General examination did not reveal abnormal findings except the skin lesion. Direct examination of skin scrapings in 10% KOH revealed broad, sparsely septate, branching hyphae. Histopathology showed many intradermal granulomata and microabscesses as well as mycelial elements comprising broad, distorted, ribbon-like strands. Some of them were phagocytized by multi-nucleated giant cells. Cultures revealed rapidly growing yellow colonies on Sabouraud dextrose agar medium at 25 degrees C. Sporangiophores branched in sympodia and the sporangia were globose, 35-60 microns in diameter. Their walls were deliquescent, but some of them were rather persistent. Columellae were mostly globose, 12-17 microns in diameter, up to 35 microns with collars. Sporangiospores were mainly ellipsoidal, 1.5-2.5 x 3-5 microns in size, but sometimes highly variable in size and shape. The maximum growth temperature of the isolate was 37 degrees C. The pathogenic organism isolated was tentatively identified as Mucor lusitanicus, which, as far as we know, has not been reported as a causative agent of cutaneous mucormycosis.

Mucor circinelloides Was Identified by Molecular Methods as a Cause of Primary Cutaneous Zygomycosis

“…Although Mucor species have been associated with a variety of invasive diseases, primary cutaneous zygomycosis has rarely been reported (16). Three cases of this disease caused by M. circinelloides are described in the literature (2,7,26). In these cases, patients were females ranging in age from 23 to 60 years, and all were known or suspected to have been exposed following trauma of either the left forearm (2), the chest (7), or the right hand (26).…”

“…Phenotypic methods have traditionally been used to identify clinically important Mucor species (2,7,26). However, the fact that most published reports refer only to the genus Mucor underlines the difficulties in species identification (16).…”

“…Three cases of this disease caused by M. circinelloides are described in the literature (2,7,26). In these cases, patients were females ranging in age from 23 to 60 years, and all were known or suspected to have been exposed following trauma of either the left forearm (2), the chest (7), or the right hand (26). Hematological malignancy was the underlying disease in two cases (acute myelocytic leukemia and MDS, respectively), but no underlying disease was recognized in the third case.…”

Zygomycetes in Human Disease

“…Spores have been demonstrated in air or dust samples obtained from both the home and hospital Erythema is often noted surrounding the lesions. Erythematous papules, nodules, and plaques without superficial necrosis have also been described (130,274,372,490). A single case described the formation of verrucous lesions (98).…”

“…A single case described the formation of verrucous lesions (98). Shallow ulcerations have also been described (490). Some patients have demonstrated chronic infections that persisted for months or years (477,490).…”