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Skin mucormycosis presenting as an erythema-nodosum-like rash in a renal transplant recipient: a case report.

Nouri-Majalan N, Moghimi M - J Med Case Rep (2008)

Bottom Line: Mucormycosis was diagnosed by skin biopsy.Microscopic examination also showed panniculitis.The patient was treated successfully with amphotericin B and surgical resection.

View Article: PubMed Central - HTML - PubMed

Affiliation: Nephrology Department, Sadoughi Medical University, Yazd, Iran. dr_nori_majelan@yahoo.com

ABSTRACT

Introduction: Cutaneous mucormycosis is a rare entity related to kidney transplantation. It usually presents with ecthyma-like lesions and black necrotic cellulitis. We report an unusual case of primary cutaneous mucormycosis presenting as erythema-nodosum-like lesions in a woman who had received a renal transplant.

Case presentation: A 49-year-old woman with diabetes received a living-unrelated kidney transplant. Her clinical course was uneventful for the first six months after transplantation. She then developed multiple, painful, erythema-nodosum-like lesions on her right leg and thigh following an episode of minor trauma. Mucormycosis was diagnosed by skin biopsy. Microscopic examination also showed panniculitis. The patient was treated successfully with amphotericin B and surgical resection. To our knowledge, this is the first description of primary cutaneous mucormycosis with erythema-nodosum-like lesions and panniculitis after renal transplantation.

Conclusion: Cutaneous mucormycosis should be considered in the differential diagnosis when a kidney transplant recipient develops erythema-nodosum-like lesions with panniculitis.

No MeSH data available.


Related in: MedlinePlus

Broad, aseptate and thin walled fungal hyphae having irregular, non-parallel contours, with right angle branching indicative of mucormycosis (PAS × 1000).
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Figure 3: Broad, aseptate and thin walled fungal hyphae having irregular, non-parallel contours, with right angle branching indicative of mucormycosis (PAS × 1000).

Mentions: Laboratory tests showed her hemoglobin was 8.6 g/dL, her total white cell count was 100,000/mm3, and her ESR was 125 mm for the first hour. Serum biochemistry showed her creatinine was 1.1 mg/dL, her fasting blood sugar was 191 mg/dL, her uric acid was 2.6 mg/dL and her lactate dehydrogenase was 625 IU/L. She was negative for cytomegalovirus (CMV) IgM, but positive for CMV IgG, which had also been positive prior to pretransplantation. Her chest X-ray was unremarkable. Right leg MRI showed severe thickening of the superficial soft tissue and skin, but no evidence of deep soft tissue or muscular structure involvement. Histological examination of deep incisional biopsies of some of the nodules revealed lobular panniculitis with infiltrating lymphocytes, neutrophils, multinucleated giant cells, foamy macrophages, fat necrosis and granulation tissue [Additional file 2]. Hematoxylin-eosin (H&E) and periodic acid schiff (PAS) staining showed numerous broad, aseptate and irregularly branched fungal hyphae indicative of mucormycosis deposited within the hypoderm and vessel wall (Figure 2) (Figure 3) [Additional file 3]. Specimen culture was negative for zygomycetes.


Skin mucormycosis presenting as an erythema-nodosum-like rash in a renal transplant recipient: a case report.

Nouri-Majalan N, Moghimi M - J Med Case Rep (2008)

Broad, aseptate and thin walled fungal hyphae having irregular, non-parallel contours, with right angle branching indicative of mucormycosis (PAS × 1000).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2365968&req=5

Figure 3: Broad, aseptate and thin walled fungal hyphae having irregular, non-parallel contours, with right angle branching indicative of mucormycosis (PAS × 1000).
Mentions: Laboratory tests showed her hemoglobin was 8.6 g/dL, her total white cell count was 100,000/mm3, and her ESR was 125 mm for the first hour. Serum biochemistry showed her creatinine was 1.1 mg/dL, her fasting blood sugar was 191 mg/dL, her uric acid was 2.6 mg/dL and her lactate dehydrogenase was 625 IU/L. She was negative for cytomegalovirus (CMV) IgM, but positive for CMV IgG, which had also been positive prior to pretransplantation. Her chest X-ray was unremarkable. Right leg MRI showed severe thickening of the superficial soft tissue and skin, but no evidence of deep soft tissue or muscular structure involvement. Histological examination of deep incisional biopsies of some of the nodules revealed lobular panniculitis with infiltrating lymphocytes, neutrophils, multinucleated giant cells, foamy macrophages, fat necrosis and granulation tissue [Additional file 2]. Hematoxylin-eosin (H&E) and periodic acid schiff (PAS) staining showed numerous broad, aseptate and irregularly branched fungal hyphae indicative of mucormycosis deposited within the hypoderm and vessel wall (Figure 2) (Figure 3) [Additional file 3]. Specimen culture was negative for zygomycetes.

Bottom Line: Mucormycosis was diagnosed by skin biopsy.Microscopic examination also showed panniculitis.The patient was treated successfully with amphotericin B and surgical resection.

View Article: PubMed Central - HTML - PubMed

Affiliation: Nephrology Department, Sadoughi Medical University, Yazd, Iran. dr_nori_majelan@yahoo.com

ABSTRACT

Introduction: Cutaneous mucormycosis is a rare entity related to kidney transplantation. It usually presents with ecthyma-like lesions and black necrotic cellulitis. We report an unusual case of primary cutaneous mucormycosis presenting as erythema-nodosum-like lesions in a woman who had received a renal transplant.

Case presentation: A 49-year-old woman with diabetes received a living-unrelated kidney transplant. Her clinical course was uneventful for the first six months after transplantation. She then developed multiple, painful, erythema-nodosum-like lesions on her right leg and thigh following an episode of minor trauma. Mucormycosis was diagnosed by skin biopsy. Microscopic examination also showed panniculitis. The patient was treated successfully with amphotericin B and surgical resection. To our knowledge, this is the first description of primary cutaneous mucormycosis with erythema-nodosum-like lesions and panniculitis after renal transplantation.

Conclusion: Cutaneous mucormycosis should be considered in the differential diagnosis when a kidney transplant recipient develops erythema-nodosum-like lesions with panniculitis.

No MeSH data available.


Related in: MedlinePlus