Fatal Cutaneous Mucormycosis Caused by Apophysomyces elegans: A Case Report and Review of Literature

Abstract

Primary cutaneous mucormycosis is a consequence of environmental Mucorales spores inoculation at the abraded skin. In a diabetic patient, these spores germinate quickly and disseminate hematogenously to the surroundings. Cutaneous mucormycosis is a rare but aggressive, invasive, and life-threatening fungal infection. Its presentation is nonspecific, but it rapidly results in necrosis of underneath tissues. Diagnosis can be readily made by KOH wet mount of excise tissue. However, a prompt diagnosis with multidisciplinary management is a prerequisite for a better outcome. We present a case of fatal cutaneous mucormycosis caused by Apophysomyces elegans, in a diabetic patient who succumbed to death despite extensive debridement and antifungal treatment.

Mucormycosis caused by Apophysomyces species: An experience from a tertiary care hospital in Western India and systematic review of global cases

“…From literature search and meticulous study selection process, 89 studies were included in this systematic review with data retrieved from additional 250 cases of mucormycosis due to Apophysomyces species 5,9–96 (Figure 1). The worldwide distribution of reported cases of mucormycosis due to Apophysomyces species is shown in Figure 2.…”

Alternative in-vivo models of mucormycosis

“…Worldwide, the majority of infections is attributed to the genera Rhizopus , Lichtheimia and Mucor ( Figure 1A ). Depending on geography and/or underlying disease, the species distribution varies and other genera such as Apophysomyces , Saksenaea — both often associated with cutaneous mucormycosis ( Al-Zaydani et al., 2015 ; Sigera et al., 2018 ; Chander et al., 2021 ; Gupta et al., 2022 ; Planegger et al., 2022 ) — Cunninghamella or Rhizomucor are reported ( Gomes et al., 2011 ; Raju et al., 2020 ; Hallur et al., 2021 ; Schober et al., 2021 ). Mucorales are ubiquitously found in the environment and share common features like the coenocytic thallus and a cell wall containing chitosan.…”