Abstract:

A 52-year-old man presented with a subcutaneous tubercle and erythema on the nasal dorsum as well as ulcerated soft palate, and suffered from nasal hemorrhage for 3 years. About 1 month prior to the presentation, a tubercle sized 0.8 cm × 0.4 cm developed under the left fossa orbitalis. He had ever received treatment with antifungal drugs such as itraconazole and fluconazole, however, the effectiveness was unsatisfactory. He had been in good health with the exception of a past history of pulmonary tuberculosis. The proportion of CD3+ T cells was decreased. Histopathology of the cutaneous lesion showed lots of inflammatory cells and multinucleated giant cells infiltrating in the mid-dermis and sub-dermis. Hematoxylin-eosin and PAS staining revealed the presence of some grossus and aseptate hyphae. The clinical isolate was identified as Rhizomucor variabilis by culture and molecular biology, and the case was diagnosed as primary cutaneous mucormycosis. Susceptibility test disclosed that the clinical strain was sensitive to amphotericin B, but resistant to itraconazole, ketoconazole and fluconazole in vitro. After 6-week treatment with oral amphotericin B （total dose, 821 mg）, the lesion obviously subsided; the biopsy tissue from the nasal dorsum and soft palate was subjected to second histopathology which revealed a decrease in the number of inflammatory cells and absence of hyphae, and the fungal culture of biopsy tissue at 26 ℃ and 32 ℃ （± 3 ℃） for 3 weeks was negative. Finally, the patient achieved a clinical, histopathological and mycological cure. During the treatment course, he experienced poor appetite, drug-induced impairment of renal function and transient kaliopenia.

Key words: Rhizomucor variabilis, Amphotericin B, Mycoses, Nasal part