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Amphotericin-B/immunosuppressants/posaconazole Cutaneous mucormycosis due to disseminated Rhizomucor pusillus and lack of efficacy: case report

A 27-year-old woman developed cutaneous mucormycosis due to haematogenous dissemination of Rhizomucor pusillus during immunosuppressant therapy with antithymocyte globulin, ciclosporin, cyclophosphamide and mycophenolate mofetil. Additionally, she exhibited lack of efficacy during treatment with amphotericin-B and posaconazole for the mucormycosis [not all routes, dosages and time to reaction onset stated]. The woman, who had acute myelomonocytic leukaemia, received conditioning treatment for haematopoetic stem cell transplantation. The conditioning regimen was cyclophosphamide and antithymocyte globulin [antilymphocytic serum]. She also received total body irradiation. After the allogenic transplantation, immunosuppression with ciclosporin and mycophenolate mofetil was initiated. About 1 month after the initiation of ciclosporin and mycophenolate mofetil, a nodular necrotic and painful lesion was noted on the palm of the left hand without any other clinical manifestations. Histopathological analysis of the lesion showed numerous fungal hyphae in the dermis within the vessels, which led to vascular occlusions. A CT scan revealed 3 nodular infiltrates in the right lung, indicating a pulmonary fungal infection without other visceral involvement. The skin culture identified Rhizomucor pusillus. The fungal hyphae were only observered in the lumen and wall of the blood vessels (septic emboli). Based on these findings, the cutaneous mucormycosis due to haematogenous dissemination of Rhizomucor pusillus (disseminated mucormycosis) was diagnosed. The woman was treated with amphotericin-B 7 mg/kg, posaconazole and topical amphotericin-B on the left hand. Forty-eight hours later, a control CT scan revealed a slight increase in nodule size and the presence of a fourth nodule in the left lung, suggesting lack efficacy to amphotericin-B and posaconazole. She exhibited impaired hepatic function [aetiology not stated], and amphotericinB and posaconazole were stopped. Subsequently, she died due to unspecified cause. Menzinger S, et al. Cutaneous Mucormycosis Resulting from Hematogenous Dissemination of Rhizomucor pusillus in an Immunocompromised Patient. Dermatopathology 6: 803505060 275-278, No. 4, Jan 2019. Available from: URL: http://doi.org/10.1159/000506272

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Reactions 3 Oct 2020 No. 1824