Advertisement

Successful Treatment of Eczema-Like Mucormycosis in a Child by Combination of Intravenous Drip and Percutaneous Injection Amphotericin B

  • Mei-hua Fu
  • Jia Liu
  • Guan-zhao Liang
  • Cheng-rang Li
  • Xiao-mei Zhu
  • Le Wang
  • Hao Chen
  • Wen-long Hu
  • Gui-xia Lv
  • Wei-da LiuEmail author
Original Paper
  • 17 Downloads

Abstract

We report a case of eczema-like cutaneous mucormycosis caused by Rhizopus arrhizus. A 4-year-old child was presented to our hospital with a history of gradually enlarging papule and plaque in the periumbilical area for nearly 4 years since 2 weeks after his birth, and it has been misdiagnosed as eczema for nearly 3 years. Based on histopathology examination, the fungus culture test and DNA sequencing, it was revealed that R. arrhizus should be the responsible fungus for skin infection. The patient was successfully cured by combination of intravenous drip and percutaneous injection amphotericin B for nearly 3 months, and no recrudescence was seen during a follow-up of 6-month observation.

Keywords

Mucormycosis Rhizopus Child Eczema-like 

Notes

Acknowledgements

This study was funded by Special Program for Basic work of science and technology, funded by the Ministry of Science and Technology of China (2013FY113700), supported by National Natural Science Foundation of China (81471905) and was funded by the Chinese Academy Medical Sciences Initiative for Innovative Medicine (2016-I2M-3-021).

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Binder U, Maurer E, Lass-Florl C. Mucormycosis—from the pathogens to the disease. Clin Microbiol Infect Off Publ Eur Soc Clin Microbiol Infect Dis. 2014;20(Suppl 6):60–6.  https://doi.org/10.1111/1469-0691.12566.CrossRefGoogle Scholar
  2. 2.
    Barratt DM, Van Meter K, Asmar P, Nolan T, Trahan C, Garcia-Covarrubias L, et al. Hyperbaric oxygen as an adjunct in zygomycosis: randomized controlled trial in a murine model. Antimicrob Agents Chemother. 2001;45(12):3601–2.  https://doi.org/10.1128/AAC.45.12.3601-3602.2001.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Roden MM, Zaoutis TE, Buchanan WL, Knudsen TA, Sarkisova TA, Schaufele RL, et al. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis. 2005;41(5):634–53.  https://doi.org/10.1086/432579.CrossRefPubMedGoogle Scholar
  4. 4.
    Liang GZ, Xu WQ, Zheng XL, Mei H, Lv GX, Shen YN, et al. Successful treatment by surgery of a primary cutaneous mucormycosis caused by mucor irregularis. Mycopathologia. 2017.  https://doi.org/10.1007/s11046-017-0219-4.CrossRefPubMedGoogle Scholar
  5. 5.
    Lu XL, Liu ZH, Shen YN, She XD, Lu GX, Zhan P, et al. Primary cutaneous zygomycosis caused by rhizomucor variabilis: A new endemic zygomycosis? A case report and review of 6 cases reported from China. Clin Infect Dis. 2009;49(3):e39–43.  https://doi.org/10.1086/600817.CrossRefPubMedGoogle Scholar
  6. 6.
    CLSI. Reference method for broth dilution antifungal susceptibility testing of filamentous fungi: Approved standard-Second Edition. CLSI document M38-A2. Wayne, PA: Clinical and Laborary Standards Institute; 2008.Google Scholar
  7. 7.
    Pana ZD, Seidel D, Skiada A, Groll AH, Petrikkos G, Cornely OA, et al. Invasive mucormycosis in children: an epidemiologic study in European and non-European countries based on two registries. BMC Infect Dis. 2016;16(1):667.  https://doi.org/10.1186/s12879-016-2005-1.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Sundararajan T, Kumar CPG, Menon T, Rekha K, Venkatadesikalu M. Cutaneous zygomycosis due to Rhizopus oryzae in a patient with acute lymphoblastic leukemia. Mycoses. 2004;47:521–3.CrossRefGoogle Scholar
  9. 9.
    Zhang AP, Liu W, Hu B. Cutaneous mucormycosis due to Rhizopus arrhizus: report 3 cases. J Clin Dermatol. 2012;41(3):163–5 (in Chinese with English abstract).Google Scholar
  10. 10.
    Wattier RL, Dvorak CC, Hoffman JA, Brozovich AA, Bin-Hussain I, Groll AH, et al. A prospective, international cohort study of invasive mold infections in children. J Pediatr Infect Dis Soc. 2015;4(4):313–22.  https://doi.org/10.1093/jpids/piu074.CrossRefGoogle Scholar
  11. 11.
    Prasad PA, Vaughan AM, Zaoutis TE. Trends in zygomycosis in children. Mycoses. 2012;55(4):352–6.  https://doi.org/10.1111/j.1439-0507.2011.02124.x.CrossRefPubMedGoogle Scholar
  12. 12.
    Dabritz J, Attarbaschi A, Tintelnot K, Kollmar N, Kremens B, von Loewenich FD, et al. Mucormycosis in paediatric patients: demographics, risk factors and outcome of 12 contemporary cases. Mycoses. 2011;54(6):e785–8.  https://doi.org/10.1111/j.1439-0507.2011.02025.x.CrossRefPubMedGoogle Scholar
  13. 13.
    Rubin AI, Grossman ME. Bull’s-eye cutaneous infarct of zygomycosis: a bedside diagnosis confirmed by touch preparation. J Am Acad Dermatol. 2004;51(6):996–1001.  https://doi.org/10.1016/j.jaad.2004.07.027.CrossRefPubMedGoogle Scholar
  14. 14.
    Cantatore-Francis JL, Shin HT, Heilman E, Glick SA. Primary cutaneous zygomycosis in two immunocompromised children. Pediatr Dermatol. 2007;24(3):257–62.  https://doi.org/10.1111/j.1525-1470.2007.00398.x.CrossRefPubMedGoogle Scholar
  15. 15.
    Cornely OA, Arikan-Akdagli S, Dannaoui E, Groll AH, Lagrou K, Chakrabarti A, et al. ESCMID and ECMM joint clinical guidelines for the diagnosis and management of mucormycosis 2013. Clin Microbiol Infect Off Publ Eur Soc Clin Microbiol Infect Dis. 2014;20(Suppl 3):5–26.  https://doi.org/10.1111/1469-0691.12371.CrossRefGoogle Scholar
  16. 16.
    Martin LB, Rodriguez MAM, Mercier N, Lafont MO, Fernandez EO, de la Parte AR, et al. Rhizopus arrhizus invasive infection due to self-inflicted scratch injuries in a diabetic patient with non-ketotic acidosis. Mycopathologia. 2017;182(9–10):927–31.  https://doi.org/10.1007/s11046-017-0158-0.CrossRefPubMedGoogle Scholar
  17. 17.
    Zaoutis TE, Roilides E, Chiou CC, Buchanan WL, Knudsen TA, Sarkisova TA, et al. Zygomycosis in children: a systematic review and analysis of reported cases. Pediatr Infect Dis J. 2007;26(8):723–7.  https://doi.org/10.1097/INF.0b013e318062115c.CrossRefPubMedGoogle Scholar
  18. 18.
    Shoham S, Magill SS, Merz WG, Gonzalez C, Seibel N, Buchanan WL, et al. Primary treatment of zygomycosis with liposomal amphotericin B: analysis of 28 cases. Med Mycol. 2010;48(3):511–7.  https://doi.org/10.3109/13693780903311944.CrossRefPubMedGoogle Scholar
  19. 19.
    van Burik JAH, Hare RS, Solomon HF, Corrado ML, Kontoyiannis DP. Posaconazole is effective as salvage therapy in zygomycosis a retrospective summary. Clin Infect Dis. 2006;42:e61–5.CrossRefGoogle Scholar
  20. 20.
    De Decker K, Van Poucke S, Wojciechowski M, Ieven M, Colpaert C, Vogelaers D, et al. Successful use of posaconazole in a pediatric case of fungal necrotizing fasciitis. Pediatr Crit Care Med J Soc Crit Care Med World Fed Pediatr Intensive Crit Care Soc. 2006;7(5):482–5.  https://doi.org/10.1097/01.pcc.0000235255.68759.05.CrossRefGoogle Scholar
  21. 21.
    Snaith J, Burns K, Kok J, Chen S, Cheung NW. A case of rhino-orbital mucormycosis in diabetes with haematogenous cerebral spread. Med Mycol Case Rep. 2016;13:22–4.  https://doi.org/10.1016/j.mmcr.2016.10.002.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Wildenbeest JG, Oomen MW, Bruggemann RJ, de Boer M, Bijleveld Y, van den Berg JM, et al. Rhizopus oryzae skin infection treated with posaconazole in a boy with chronic granulomatous disease. Pediatr Infect Dis J. 2010;29(6):578.  https://doi.org/10.1097/INF.0b013e3181dc8352.CrossRefPubMedGoogle Scholar
  23. 23.
    Mushtaq S, Dogra D, Dogra N. Clinical response with intralesional amphotericin B in the treatment of old world cutaneous leishmaniasis: a preliminary report. Dermatol Ther. 2016;29(6):398–405.  https://doi.org/10.1111/dth.12377.CrossRefPubMedGoogle Scholar
  24. 24.
    Zhang DL. Nursing experience of one child with disseminated cryptococcosis. Sichuan Med J. 2005;26(6):697–8 (in Chinese).Google Scholar
  25. 25.
    Nikandish M, Goyonlo VM, Taheri AR, Kiafar B. Ocular leishmaniasis treated by intralesional amphotericin B. Middle East Afr J Ophthalmol. 2016;23(1):153–5.  https://doi.org/10.4103/0974-9233.171801.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Goyonlo VM, Vosoughi E, Kiafar B, Nahidi Y, Momenzadeh A, Taheri AR. Efficacy of intralesional amphotericin B for the treatment of cutaneous leishmaniasis. Indian J Dermatol. 2014;59(6):631.  https://doi.org/10.4103/0019-5154.143571.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Vitale RG, de Hoog GS, Schwarz P, Dannaoui E, Deng S, Machouart M, et al. Antifungal susceptibility and phylogeny of opportunistic members of the order mucorales. J Clin Microbiol. 2012;50(1):66–75.  https://doi.org/10.1128/JCM.06133-11.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2019

Authors and Affiliations

  • Mei-hua Fu
    • 1
  • Jia Liu
    • 1
  • Guan-zhao Liang
    • 1
  • Cheng-rang Li
    • 2
  • Xiao-mei Zhu
    • 4
  • Le Wang
    • 3
  • Hao Chen
    • 4
  • Wen-long Hu
    • 5
  • Gui-xia Lv
    • 1
  • Wei-da Liu
    • 1
    Email author
  1. 1.Department of Mycology, Institute of DermatologyChinese Academy of Medical Sciences and Peking Union Medical CollegeNanjingChina
  2. 2.Institute of DermatologyChinese Academy of Medical Sciences and Peking Union Medical CollegeNanjingChina
  3. 3.Department of Cosmetic Laser Surgery, Institute of DermatologyChinese Academy of Medical Sciences and Peking Union Medical CollegeNanjingChina
  4. 4.Department of Pathology, Institute of DermatologyChinese Academy of Medical Sciences and Peking Union Medical CollegeNanjingChina
  5. 5.Division of Sexually Transmitted Disease Epidemiology, Institute of DermatologyChinese Academy of Medical Sciences and Peking Union Medical CollegeNanjingChina

Personalised recommendations