Successful treatment of cutaneous mucormycosis disseminated from pulmonary mucormycosis with liposomal amphotericin B and posaconazole

摘要

A 52-year-old man presented with fever and a painful ulcer on the right thigh for 10 days. The patient had acute lymphoblastic leukemia for 2 years. Two months ago, the patient developed cough and expectoration. Blood and lung tissue cultures gave negative results but the serum 1,3-β-D-glucan assay was positive. Chest computed tomography (CT) showed new exudation in the right lung. A diagnosis of pulmonary fungal infection was made. Ten days ago, the patient began to suffer from fever, meanwhile a small erythema was noticed on the right thigh with severe pain. The lesion enlarged rapidly and became an ulcer in the center. Physical examination showed a 2 cm × 4 cm ulcer with surrounding erythema and induration on the right thigh, necrotic eschar can be seen on the ulcer without purulent secretion and exudation [Figure A]. Histopathology revealed hyperplasia of epidermis and dermal perivascular infiltration of lymphocytes, neutrophils, and plasma cells. Thrombosis of blood vessel was seen in the dermis [Figure B]. Hematoxylin-eosin and periodic acid-Schiff stain both revealed the similar broad non-septate hyphae with right-angle in thrombosis [Figure B and C]. The direct microscopy of the lesion and the polymerase chain reaction (PCR) assay for mucormycosis in formalin-fixed paraffin-embedded tissue were negative. Based on the history, clinical examination, and histopathology, the patient was diagnosed as disseminated mucormycosis. Intravenous liposomal amphotericin B 50 mg/d and posaconazole 800 mg/d was given for the treatment. Four weeks later, chest CT scan revealed great improvement and the skin ulcer healed with crusts on it [Figure D].