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Abstract

Background: Mucormycosis is a rare fungal infection caused by a group of opportunistic fungi from the class Zygomycetes. Primary cutaneous mucormycosis is the most common type of mucormycosis in immunocompetent patients. This study reported a case of primary cutaneous mucormycosis with nonspecific clinical characteristics and various supporting examinations. The patient was successfully treated with in toto excision and oral ketoconazole.

Case Illustration: A 40-year-old female presented with purplish-red spots and painless lumps on the second finger of her right hand, which had been present for a year. She had a history of frequent fish tank cleaning and gardening but denied any known injury. Physical examination revealed multiple well-circumscribed and confluent erythematous-violaceous plaques and nodules. An in toto excisional biopsy was performed for histopathological examination, culture, and a rapid molecular test (RMT) using the Xpert MTB/RIF® test (Cepheid, USA). Histopathological examination revealed granulomatous suppurative inflammation, and fungal culture revealed growth of Mucor species.

Discussion: Clinical findings in cutaneous mucormycosis are nonspecific. The diagnosis is confirmed by identifying the organism through biopsy and histopathological examination, as well as culture. Histopathology will reveal granulomas in the dermis and subcutis containing numerous macrophages and Langhans giant cells, often with phagocytosed fungal elements. Fungal culture yields positive results in 72–89% of cases of skin mucormycosis conducted on Sabouraud and potato dextrose agar media.

Conclusion: This case emphasizes the need for broad differential consideration and thorough diagnostic workup in nonspecific cutaneous mucormycosis and supports surgical excision with systemic antifungal therapy for chronic, localized primary disease.

References

  1. Mekki SO, Hassan AA, Falemban A, et al. Pulmonary mucormycosis: A case report of a rare infection with potential diagnostic problems. Case Rep Pathol. 2020;2020:1–4.
  2. Skiada A, Pavleas I, Drogari-Apiranthitou M. Epidemiology and diagnosis of mucormycosis: An update. J Fungi (Basel). 2020;6(4):1–20.
  3. Sharma A, Goel A. Mucormycosis: Risk factors, diagnosis, treatments, and challenges during the COVID-19 pandemic. Folia Microbiol (Praha). 2022;67(3):363–87.
  4. Prakash H, Chakrabarti A. Global epidemiology of mucormycosis. J Fungi (Basel). 2019;5(1):1–19.
  5. Castrejón-Pérez AD, Welsh EC, Miranda I, Ocampo-Candiani J, Welsh O. Cutaneous mucormycosis. An Bras Dermatol. 2017;92(3):304–11.
  6. Chander J, Kaur M, Bhalla M, et al. Changing epidemiology of mucoralean fungi: Chronic cutaneous infection caused by Mucor irregularis. Mycopathologia. 2015;180(3-4):181–6.
  7. Matsudate Y, Murao K, Urano Y, et al. Primary cutaneous mucormycosis caused by Mucor irregularis in an immunocompetent patient. J Dermatol. 2015;42(3):267–8.
  8. Paduraru M, Moreno-Sanz C, Gallarado OJM. Primary cutaneous mucormycosis in an immunocompetent patient. BMJ Case Rep. 2016;2016:1–4.
  9. Bonifaz A, Vázquez-González D, Tirado-Sánchez A, Ponce-Olivera RM. Cutaneous zygomycosis. Clin Dermatol. 2012;30(4):413–9.
  10. Safiia J, Díaz MA, Alshaker H, et al. Recent advances in diagnostic approaches for mucormycosis. J Fungi (Basel). 2024;10(10):1–13.
  11. Sree LI, Kumari BS, Jyothi C, et al. Histopathological study of mucormycosis in post COVID-19 patients and factors affecting it in a tertiary care hospital. Int J Surg Pathol. 2023;31(1):56–63.
  12. Ribes JA, Vanover-Sams CL, Baker DJ. Zygomycetes in human disease. Clin Microbiol Rev. 2000;13(2):236–301.
  13. Ganesan N, Sivanandam S. Histomorphological features of mucormycosis with rise and fall of COVID-19 pandemic. Pathol Res Pract. 2022;236:1–7.
  14. Mohanty A, Gupta P, Arathi K, et al. Evaluation of direct examination, culture, and histopathology in the diagnosis of mucormycosis: Reiterating the role of KOH mount for early diagnosis. Cureus. 2021;13(11):1–5.
  15. Badiee P, Arastefar A, Jafarian H. Comparison of histopathological analysis, culture and polymerase chain reaction assays to detect mucormycosis in biopsy and blood specimens. Iran J Microbiol. 2013;5(4):406–10.
  16. Gupta MK, Kumar N, Dhameja N, Sharma A, Tilak R. Laboratory diagnosis of mucormycosis: Present perspective. J Family Med Prim Care. 2022;11(5):1664–71.
  17. Cornely OA, Alastruey-Izquierdo A, Arenz D, et al. Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium. Lancet Infect Dis. 2019;19(12):e405–21.
  18. Hussain MK, Ahmed S, Khan A, Siddiqui AJ, Khatoon S, Jahan S. Mucormycosis: A hidden mystery of fungal infection, possible diagnosis, treatment and development of new therapeutic agents. Eur J Med Chem. 2023;246:1–17.
  19. George M. Cutaneous non-tuberculous mycobacterial infections: An update. J Skin Sex Trans Dis. 2023;5(2):90–7.
  20. Sethi A. Tuberculosis and infections with atypical mycobacteria. In: Kang S, Amagai M, Bruckner AL, et al., editors. Fitzpatrick’s dermatology. 9th ed. New York: McGraw Hill Education; 2019. p. 2858–75.
  21. Gupta J, Joshi P, Gupta R, Gupta V. Comparative evaluation of GeneXpert with Ziehl-Neelsen (ZN) stain in samples of suspected tuberculosis cases at a tertiary care teaching hospital in Central India. Cureus. 2024;16(10):1–9.
  22. Hay RJ. Deep fungal infections. In: Kang S, Amagai M, Bruckner AL, et al., editors. Fitzpatrick’s dermatology. 9th ed. New York: McGraw Hill Education; 2019. p. 2965–87.
  23. Carrasco-Zuber JE, Navarrete-Dechent C, Bonifaz A, Fich F, Vial-Latelier V, Berroeta-Mauriziano D. Cutaneous involvement in the deep mycoses: A literature review. Part I—Subcutaneous mycoses. Actas Dermosifiliogr (Engl Ed). 2016;107(10):806–15.
  24. Robinson VK, Samuel-Penu B, Minimah SO. Susceptibility of medical fungal isolates to commonly used antifungal agents. Int J Pathog Res. 2021;8(1):37–42.

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