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Arch Dermatol. 2007;143(3):417-422.

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Diagnosis: Cutaneous Rhizopus infection.

MICROSCOPIC FINDINGS AND CLINICAL COURSE

Histologic examination revealed necrotizing granulomatous inflammation with abundant yeast and broad-based, branching hyphal-phase organisms consistent with Zygomycetes. Gomori methenamine silver staining confirmed the presence of fungal organisms. Tissue culture on blood agar revealed wooly dense colonies that covered the agar plate within 48 hours. Staining with lactophenol cotton blue revealed broad, nonseptate hyphae (6-15 µm) and rhizoids (rootlike hyphae) at the branching points of sporangiophores, characteristic of Rhizopus.

A workup for systemic Rhizopus infection, including computed tomography of the sinuses, chest, and abdomen, showed no evidence of infection elsewhere, and emergent surgical excision of the skin lesions was performed. Voriconazole therapy was discontinued, and a 2-week course of liposomal amphotericin B was initiated at a dose of 5 mg/kg per day. The patient continued to have intermittent fevers resulting from persistent chronic lymphocytic leukemia, which subsided during empirical steroid therapy with prednisone (40 mg/d), but had no further evidence . . . [Full Text of this Article]

DISCUSSION

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Arch Dermatol. 2007;143(3):417-422.
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