By Gary M. White, MD
Primary cutaneous mucormycosis (PCM) represents infection of the skin by any fungi of the order Mucorales (which falls within in the broader zygomycota phylum). Mucorales are found in decaying vegetation and soil and release a large number of spores. Sources of infection include inhalation (most commonly), percutaneous inoculation, and ingestion of spores. Compared to other filamentous fungi, it is rare for systemic mucormycosis to spread to the skin. Many patients are not only immunocompromised but IV drug users as well. Local tissue damage also seems to be a risk factor.
Any ecthyma-like lesions in an immunocompromised patient should raise the possibility of PCM. Skin biopsy of the leading edge stained with PAS allows for easy diagnosis. The infection may disseminate.
The main signs and symptoms observed are odontalgia, sinusitis, facial swelling and cellulitis, nasal obstruction, and nasal discharge. In advanced cases, dramatic necrosis and destruction of the central face may occur.
Amphotericin B is the usual treatment of mucormycosis.
A large, necrosing ulcer on the arm of a 66 year old man with mantle-cell lymphoma and neutropenia. Dermatology Online Journal 2015;21
Dramatic facial necrosis in a patient with RM. Case Rep Med. 2014; 2014: 527062.
Gangrene nose in a diabetic: a rare presentation of Rhino-orbital-cerebral mucormycosis. The Internet Journal of Ophthalmology 2008;10;1
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