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Vacuum-Assisted Closure and Skin Grafting Combined with Amphotericin B for Successful Treatment of an Immunocompromised Patient with Cutaneous Mucormycosis Caused by Mucor irregularis: A Case Report and Literature Review

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Abstract

Cutaneous mucormycosis caused by Mucor irregularis (M. irregularis) is a rare condition that typically occurs in immunocompetent patients. Herein, we describe an immunocompromised patient with cutaneous M. irregularis infection who was successfully treated with debridement combined with vacuum assisted closure (VAC) negative pressure technique and split-thickness skin grafting. We present this case owing to its complexity and rarity and the successful treatment with surgical therapy. A 58-year-old man presented to our hospital with a history of skin ulcers and eschar on the right lower leg since two months. He had been receiving methylprednisolone therapy for bullous pemphigoid that occurred five months prior to the present lesions. Histopathological examination of a right leg lesion showed broad, branching hyphae in the dermis. Fungal culture and subsequent molecular cytogenetic analysis identified the pathogen as M. irregularis. After admission, methylprednisolone was gradually tapered and systemic treatment with amphotericin B (total dose 615 mg) initiated along with others supportive therapies. However, the ulcers showed no improvement, and amphotericin B had to be discontinued owing to development of renal dysfunction. After extensive surgical debridement combined with VAC and skin grafting, his skin ulcers were healed; subsequent fungal cultures of the lesions were negative. The patient exhibited no signs of recurrence at 36-month follow-up. Twenty-six cases with M. irregularis-associated cutaneous mucormycosis in literature were reviewed.

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Acknowledgements

We are indebted to the mycological laboratory staff of department of Dermatology & Venereology, Research Center for Medical Mycology, Peking University First Hospital, including Prof. Ruoyu Li; Zhe Wan, PhD, without whose invaluable assistance, antifungal drug sensitivity test in vitro in this study could not have been performed. We also appreciate greatly the valuable comments on the diagnosis of this case from Prof. Liyan Xi, Sun Yat-sen Memorial Hospital, Sun Yat-sen University.

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Authors and Affiliations

  1. Department of Dermatology, The First Affiliated Hospital, Sun Yat-Sen University, No. 58, Zhongshan 2nd Road, Guangzhou, 510080, China

    Xuhua Tang, Hioteng Wong, Jiande Han & Hui Zhou

  2. Department of Clinical Laboratory, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China

    Penghao Guo

  3. Department of Dermatology, the First People’s Hospital of Shaoguan, Shaoguan, 512000, China

    Jiahui Xie

  4. Department of Burns, The First Affiliated Hospital, Sun Yat-Sen University, No. 58, Zhongshan 2nd Road, Guangzhou, 510080, China

    Yingbin Xu

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  1. Xuhua Tang
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  2. Penghao Guo
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  4. Jiahui Xie
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Contributions

HZ and YX were the guarantors for the entire manuscript; HZ and PG participated in conception and design of the work; HZ, PG, XT, HW, JX, JH and YX contributed to data collection of patient; XT and PG wrote the paper; HZ, PG, XT, HW, JX, JH and YX participated in analyzing data and revising the manuscript for significant intellectual content; all authors approved the final manuscript.

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Correspondence to Yingbin Xu or Hui Zhou.

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Tang, X., Guo, P., Wong, H. et al. Vacuum-Assisted Closure and Skin Grafting Combined with Amphotericin B for Successful Treatment of an Immunocompromised Patient with Cutaneous Mucormycosis Caused by Mucor irregularis: A Case Report and Literature Review. Mycopathologia 186, 449–459 (2021). https://doi.org/10.1007/s11046-021-00551-3

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