Soft Tissue Infection with Absidia corymbifera in a Patient with Idiopathic Aplastic Anemia

Abstract

We describe a case of primary cutaneous mucormycosis (zygomycosis) in a patient with idiopathic aplastic anemia which responded to surgical debridement and therapy with liposomal amphotericin B. The tissue removed at surgery showed dense infiltration with fungal hyphae on histopathological examination. Primary cultures of tissue on solid media were negative, but Absidia corymbifera was isolated from unprocessed tissue placed in brain heart infusion broth. CASE REPORTA nineteen-year-old man with aplastic anemia was referred to a tertiary referral hospital in February 2000. He initially presented to another hospital with a 1-week history of bleeding gums associated with tooth brushing. Pancytopenia was detected on full blood count, and bone marrow examination confirmed bone marrow aplasia. Upon admission to this hospital, he was febrile and pale and had multiple bruises.Broad-spectrum empirical antibacterial therapy with piperacillin-tazobactam and gentamicin was commenced. Because he remained pyrexial, vancomycin and subsequently fluconazole (400 mg daily) were added. On hospital day 4, an area of ecchymoses was noted on the dorsal aspect of the left forearm. The patient had no recollection of preceding trauma at the site of the lesion. The lesion became more extensive and necrotic over 2 days. Empirical therapy with liposomal amphotericin B (3 mg/kg of body weight) was commenced on hospital day 6 based on a clinical suspicion of mold infection, and fluconazole was discontinued at this point. The lesion was immediately and thoroughly debrided. Clinical and radiological assessment, including sinus and chest X ray, revealed no evidence of disease at other sites. Further debridement was performed on hospital day 13, and on day 15, the wound was grafted with skin from the left inner thigh. On day 17, he was transferred to another hospital for HLA-matched bone marrow transplantation. Liposomal amphotericin B was continued until the bone marrow engraftment was confirmed and the forearm lesion was healed. At no point in his clinical course was there clinical or radiological evidence of mucormycosis at any other site. The patient remains well more than 1 year post-bone marrow transplantation.

Prevalence and risk factors for skin diseases among antiretroviral‐naïve HIV‐infected pregnant women in Dar es Salaam, Tanzania

“…Fiftythree percent of the study population was aged < 25 years. The median gestational age (interquartile range) at enrollment was 24 weeks (21)(22)(23)(24)(25)(26)(27)(28). The majority of the women (82%) attained primary education, while 89% were married or cohabiting.…”

“…3,24 A low hemoglobin level was associated with an increased prevalence for both fungal infections and genital ulcers. Though it was beyond the scope of this study to identify the type of anemia, aplastic anemia has been associated with certain fungal infections 25 and anemia of chronic diseases with cutaneous ulcers. 26 The prevalence for genital ulcers was significantly higher in women who had partial support from their partners or who depended on their own source of income compared to those who received full support from partners.…”

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“…[ 40 ] Reports in the literature suggest that due to the superficial nature of these infections, early diagnosis and surgical debridement with skin grafting give highly favorable outcomes. [ 23 30 33 40 ]…”