Cutaneous Mucormycosis of the Interscapular Region in an Immunocompetent Patient

Abstract

Mucormycosis is an invasive fungal infection caused by opportunistic fungi of the phylum Glomeromycotan, subphylum Mucormycotina, mainly affecting individuals with immunosuppression. Cutaneous mucormycosis is the third most common clinical form of the disease preceded by pulmonary and rhinocerebral mucormycosis. The usual factors predisposing to this infection are individuals who are immunocompromised with conditions like HIV, haematological malignancies, and diabetes mellitus, but a significant proportion of patients are immunocompetent. The agents of mucormycosis are abundantly present in nature and are transmitted to the skin by direct inoculation. It may be due to needle sticks, stings, and bites by animals, motor-vehicle accidents, natural disasters, and burn injuries. The clinical presentation is non-specific, but an indurated plaque that rapidly evolves to necrosis (eschar) is a common finding. The infection can invade locally, and also penetrate into the adjacent fat, muscle, fascia, and bone, or become disseminated. It is difficult to diagnose because of the non-specific presentation of mucormycosis. Biopsy and culture should be performed. Treatment consists of multidisciplinary management, including surgical debridement, use of antifungal drugs (amphotericin B and posaconazole), and reversal of underlying risk factors, when possible. Mortality rates are significant, ranging from 4% to 10% in localised mucormycosis infection, but are lower than the other forms of the disease. The authors present a case here of a 38-year-old immunocompetent male with cutaneous mucormycosis at the interscapular region.