, Volume 182, Issue 3–4, pp 387–392 | Cite as

Primary Cutaneous Mucormycosis Caused by Rhizopus oryzae: A Case Report and Review of Literature

  • Erika Rodríguez-Lobato
  • Lourdes Ramírez-Hobak
  • Jorge E. Aquino-Matus
  • Juan P. Ramírez-Hinojosa
  • Víctor H. Lozano-Fernández
  • Juan Xicohtencatl-Cortes
  • Rigoberto Hernández-Castro
  • Roberto Arenas


Mucormycosis is an invasive infection caused by opportunistic fungi. Rhizopus, Lichtheimia, Mucor and Rhizomucor are the most common isolated genera. Primary cutaneous mucormycosis is usually related to traumatic injuries, but immunocompromised cases are associated with underlying conditions such as diabetes mellitus and malignancies. The treatment of choice is surgical debridement and liposomal amphotericin B. We present a 40-year-old male with fever and a painful necrotic lesion on the middle back and history of poorly controlled diabetes mellitus. Rhizopus oryzae was isolated and identified using an internal transcribed spacer regions ITS1 and ITS2. An initial good response to treatment was observed; however, 7 days later a diabetic ketoacidosis due to poor adherence to treatment caused a lethal outcome.


Primary cutaneous mucormycosis Opportunistic fungal infection Rhizopus oryzae 



We thank Cecilia González de Cossio and María Fernanda Ortega-Springall for her excellent medical assistance.

Compliance with Ethical Standards

Conflict of interest

All authors declare to have no conflict of interest.


  1. 1.
    London V, Chong S. Cutaneous mucormycosis: a case report. Cutis. 2012;89:167–8.PubMedGoogle Scholar
  2. 2.
    Korabecná M, Liska V, Fajfrlík K. Primers ITS1, ITS2 and ITS4 detect the intraspecies variability in the internal transcribed spacers and 5.8S rRNA gene region in clinical isolates of fungi. Folia Microbiol. 2003;48:233–8.CrossRefGoogle Scholar
  3. 3.
    Gomes MZ, Lewis RE, Kontoyiannis DP. Mucormycosis caused by unusual mucormycetes, non-Rhizopus, Mucor, and Lichtheimia species. Clin Microbiol Rev. 2011;24:411–45.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Roden MM, Zaoutis TE, Buchanan WL, Knudsen TA, Sarkisova TA, Schaufele RL, Sein M, Sein T, Chiou CC, Chu JH, Kontoyiannis DP, Walsh TJ. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis. 2005;41:634–53.CrossRefPubMedGoogle Scholar
  5. 5.
    Bonifaz A, Tirado-Sánchez A, Calderón L, Romero-Cabello R, Kassack J, Ponce RM, Mena C, Stchigel A, Cano J, Guarro J. Mucormycosis in children: a study of 22 cases in a Mexican hospital. Mycoses. 2014;57:79–84.CrossRefPubMedGoogle Scholar
  6. 6.
    Bonifaz A, Tirado-Sánchez A, Calderón L, Ponce RM. Cutaneous mucormycosis: mycological, clinical, and therapeutic aspects. Curr Fungal Infect Rep. 2015;9:229–37.CrossRefGoogle Scholar
  7. 7.
    Skiada A, Rigopoulos D, Larios G, Petrikkos G, Katsambas A. Global epidemiology of cutaneous zygomycosis. Clin Dermatol. 2012;30:628–32.CrossRefPubMedGoogle Scholar
  8. 8.
    Gelman A, Valdes R, Bhattacharyva S, Yosipovitch G. A case of primary cutaneous mucormycosis caused by minor trauma. Dermatol Online J. 2015;21:1–3.Google Scholar
  9. 9.
    Lelievre L, Garcia-Hermoso D, Abdoul H, Hivelin M, Chouaki T, Toubas D, Mamez AC, Lantieri L, Lortholary O, Lanternier F. Posttraumatic mucormycosis: a nationwide study in France and review of the literature. Medicine. 2014;93:395–404.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Petrikkos G, Skiada A, Lortholary O, Roilides E, Walsh TJ, Kontoyiannis DP. Epidemiology and clinical manifestations of mucormycosis. Clin Infect Dis. 2012;54:23–34.CrossRefGoogle Scholar
  11. 11.
    De Telles Filho F, Coelho A, Porto E, Lameira RF, Freitas MM, Barboza J, Ramos JL. Subcutaneous mucormycosis caused by Rhizopus oryzae probable nosocomial acquired infection. Rev Inst Med Trop Sao Paulo. 1985;27:201–6.CrossRefGoogle Scholar
  12. 12.
    Song WK, Park HJ, Cinn YW, Rheem I, Pai H, Shin JH. Primary cutaneous mucormycosis in a trauma patient. J Dermatol. 1999;26:825–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Miyamoto H, Hayashi H, Nakajima H. Cutaneous mucormycosis in a patient with acute lymphocytic leukemia. J Dermatol. 2005;32:273–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Chan Y, Goldwater P, Saxon B. Successful treatment of cutaneous and subcutaneous zygomycosis in an immunosuppressed patient with aplastic anaemia. J Paediatr Child Health. 2007;43:87–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Romano C, Ghilardi A, Massai L, Capecchi PL, Miraccco C, Fimiani M. Primary subcutaneous zygomycosis due to Rhizopus oryzae in a 71-year-old man with normal immune status. Mycoses. 2007;50:82–4.CrossRefPubMedGoogle Scholar
  16. 16.
    Salim R, Runco R, Alvarez C, Romano S, Charre M. Zigomicosis cutanea primaria por Rhyzopus oryzae en una niña con leucemia linfoblastica aguda tipo b. Bol Micol. 2008;23:35–41.Google Scholar
  17. 17.
    Wildenbeest JG, Oomen MW, Brüggemann RJ, de Boer M, Bijleveld Y, van den Berg JM, Kuijpers TW, Pajkrt D. Rhizopus oryzae skin infection treated with posaconazole in a boy with chronic granulomatous disease. Pediatr Infect Dis J. 2010;29:578–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Harman M, Uçmak D, Dal T. A rare case of mucormycosis in the scalp. Acta Med Port. 2013;26:754–7.PubMedGoogle Scholar
  19. 19.
    Li H, Hwang SK, Zhou C, Du J, Zhang J. Cutaneous mucormycosis caused by Rhizopus oryzae: a case report and review of primary cutaneous mucormycosis in China over past 20 years. Mycopathologia. 2013;176:123–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Vinay K, Chandrasegaran A, Kanwar AJ, Saikia UN, Kaur H, Shivaprakash MR, Dogra S. Primary cutaneous mucormycosis presenting as a giant plaque: uncommon presentation of a rare mycosis. Mycopathologia. 2014;178:97–101.CrossRefPubMedGoogle Scholar
  21. 21.
    Zaman K, Kaur H, Rudramurthy SM, Singh M, Parashar A, Chakrabarti A. Cutaneous mucormycosis of scalp and eyelids in a child with type I diabetes mellitus. Indian J Dermatol Venereol Leprol. 2015;81:275–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Kanemaru M, Tashima S, Yamazaki A, Masuda K, Nagoshi H, Kobayashi T, Kuroda J, Hiruma M, Taniwaki M, Katoh N. Disseminated mucormycosis due to Rhizopus oryzae diagnosed by skin biopsy. J Dermatol. 2015;42:100–1.CrossRefPubMedGoogle Scholar
  23. 23.
    Johnson M, Fathi R, Alkousakis T. Primary cutaneous mucormycosis. J Drugs Dermatol. 2015;14:915–7.Google Scholar
  24. 24.
    Gardiner BJ, Simpson I, Khuu MH, Kidd SE, Lo CH, Jenkin GA. An unusual ulcer: a case of cutaneous mucormycosis caused by Rhizopus oryzae. Med Mycol Case Rep. 2015;7:8–11.CrossRefPubMedGoogle Scholar
  25. 25.
    Lakshmi P, Kumarasamy S. Devastating posttraumatic primary cutaneous mucormycosis in a diabetic patient. J Sci Soc. 2016;43:85–8.CrossRefGoogle Scholar
  26. 26.
    Mantadakis E, Samonis G. Clinical presentation of zygomycosis. Clin Microbiol Infect. 2009;15:15–20.CrossRefPubMedGoogle Scholar
  27. 27.
    Romanelli AM, Fu J, Herrera ML, Wickes BL. A universal DNA extraction and PCR amplification method for fungal rDNA sequence-based identification. Mycoses. 2014;57:612–22.CrossRefPubMedGoogle Scholar
  28. 28.
    Kontoyiannis DP, Lewis RE. Invasive zygomycosis: update on pathogenesis, clinical manifestations, and management. Infect Dis Clin North Am. 2006;20:581–607.CrossRefPubMedGoogle Scholar
  29. 29.
    Cornely OA, Arikan-Akdagli S, Dannaoui E, Groll AH, Lagrou K, Chakrabarti A, Lanternier F, Pagano L, Skiada A, Akova M, Arendrup MC, Boekhout T, Chowdhary A, Cuenca-Estrella M, Freiberger T, Guinea J, Guarro J, de Hoog S, Hope W, Johnson E, Kathuria S, Lackner M, Lass-Flörl C, Lortholary O, Meis JF, Meletiadis J, Muñoz P, Richardson M, Roilides E, Tortorano AM, Ullmann AJ, van Diepeningen A, Verweij P, Petrikkos G. ESCMID and ECMM joint clinical guidelines for the diagnosis and management of mucormycosis 2013. Clin Microbiol Infect. 2014;20:5–26.CrossRefPubMedGoogle Scholar
  30. 30.
    Katragkou A, Walsh TJ, Roilides E. Why is mucormycosis more difficult to cure than more common mycoses? Clin Microbiol Infect. 2014;20:74–81.CrossRefPubMedGoogle Scholar
  31. 31.
    Lewis RE, Kontoyiannis DP. Epidemiology and treatment of mucormycosis. Future Microbiol. 2013;8:1163–75.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2016

Authors and Affiliations

  • Erika Rodríguez-Lobato
    • 1
  • Lourdes Ramírez-Hobak
    • 1
  • Jorge E. Aquino-Matus
    • 2
  • Juan P. Ramírez-Hinojosa
    • 3
  • Víctor H. Lozano-Fernández
    • 3
  • Juan Xicohtencatl-Cortes
    • 4
  • Rigoberto Hernández-Castro
    • 5
  • Roberto Arenas
    • 6
  1. 1.Servicio de DermatologíaHospital General Dr. Manuel Gea GonzálezTlalpanMexico
  2. 2.Departamento Medicina InternaHospital General Dr. Manuel Gea GonzálezTlalpanMexico
  3. 3.Departamento de InfectologíaHospital General Dr. Manuel Gea GonzálezTlalpanMexico
  4. 4.Laboratorio de Bacteriología IntestinalHospital Infantil de México Dr. Federico GómezCuauhtémocMexico
  5. 5.Departamento de Ecología de Agentes PatógenosHospital General Dr. Manuel Gea GonzálezTlalpanMexico
  6. 6.Sección de MicologíaHospital General Dr. Manuel Gea GonzálezTlalpanMexico

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