Primary Cutaneous Mucormycosis

Primary cutaneous inoculation is uncommon but occurs in burn eschars, underneath occlusive dressings, and at sites of minor trauma in immunocompromised adults and low-birth-weight neonates. In burn patients, Mucor generally involves the skin and only rarely causes the rhinocerebral form. In the cutaneous form of mucormycosis, presentation occurs with minimal pain, variable systemic toxicity, rapid progression with low-grade fever, and anesthesia of the lesion. The lesion appears as a central black, necrotic area with a purple raised margin or may appear as a black ulcer. Multiple reports in the literature document inoculation of Rhizopus and other spores from nonsterile elastic bandages or from the use of nonsterile tongue depressors. Use of properly sterilized bandages, dressings, and other supplies should eliminate this transmission of mucormycosis. Treatment is more successful in cutaneous mucormycosis than in other forms, though curative surgical intervention may be quite disfiguring or may require amputation of the affected limb (Table 3).

TABLE 3 Signs and Symptoms of Mucormycosis at Presentation (n = 114)

Sign/symptom

n

Frequency (%)

Fever

50

44

Nasal necrosis/ulceration

43

38

Facial/periorbital swelling

39

34

Decreased vision

34

30

Ophthalmoplegia

33

29

Sinusitis

30

26

Headache

29

25

Facial pain

25

22

Altered mental status

25

22

Leukocytosis

22

19

Nasal discharge

20

18

Nasal stuffiness

19

17

Corneal anesthesia

19

17

Palatal/gingival necrosis

16

14

Afferent papillary defect

15

13

CN VII palsy

13

11

Periorbital pain

13

11

Source: Adapted from Ref. 6.

Source: Adapted from Ref. 6.

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