The emergence of mucormycosis as an important opportunistic fungal infection: five cases presenting to a tertiary referral center for mycology.
BACKGROUND
Mucormycosis, a rare opportunistic fungal infection, is re-emerging in importance with the increase in prevalence of immunosuppressive states, both as a result of therapy and disease.


METHODS
We report five cases of mucormycosis diagnosed by the Dermatology Department and managed jointly with the Medical and Surgical Services of "Dr Manuel Gea Gonzalez" General Hospital in Mexico City, a tertiary referral center for mycology. We also review the current literature including recent advances in medical therapy.


RESULTS
Four of the five cases were of the rhino-orbital-cerebral variant, commonly associated with significant mortality, and one of these patients died despite early diagnosis and aggressive management. The fifth case was primary cutaneous mucormycosis and this patient survived infection without relapse. Diabetic ketoacidosis predisposed to infection in four cases and the other was associated with advanced human immunodeficiency virus infection. Radiologic imaging was important in cases of facial involvement in order to evaluate the extent of disease and possible intracranial involvement. All cases were managed with systemic antifungals and surgical debridement, together with the treatment of predisposing factors.


CONCLUSIONS
These cases illustrate the need for early clinical recognition and prompt therapy, as well as the requirement for tissue biopsy in order to demonstrate the characteristic morphologic features of this fungal agent in the absence of positive mycology culture results. This report also highlights that, although rhino-orbital-cerebral mucormycosis requires effective multidisciplinary management, the disease not uncommonly presents to dermatologists for diagnosis.
Ameen
Mahreen
M
Department of Mycology, Hospital General "Dr Manuel Gea Gonzalez", Tlalpan, Mexico. mahreenameen@hotmail.com
Arenas
Roberto
R
Martinez-Luna
Eduwiges
E
Reyes
Miguel
M
Zacarias
Rogelio
R
D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D000328:Adult; D000368:Aged; D019557:Dermatitis, Perioral / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D003924:Diabetes Mellitus, Type 2; D016883:Diabetic Ketoacidosis / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D003937:Diagnosis, Differential; D004487:Edema / Q000209:etiology; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D008297:Male; D009091:Mucormycosis / Q000150:complications / Q000175:diagnosis* / Q000473:pathology