Cutaneous Mucormycosis Eschar 30 M HIV cd4 10 VL 30k traumatic injury of arm few months ago during tornado: started as nodule and now progressed to eschar. Diagnosis? Cutaneous mucor in diabetics or immunosuppressed pts: usually acquired by direct inoculation via trauma. Can present as non healing ulcer or indurated plaque that evolves to eschar ubiquitous: decaying organic matter, soil, wood, cotton, bread, fruits, vegetables, animal excreta. cutaneous mucormycosis by direct inoculation, contaminated dressings, surgery, burns, accident, insulin injection site, adhesive tape, wooden tongue depressors, ostomy bags 50% isolated cutaneous mucor cases may not have underlying immunosuppressive. r.f. DM, hem CA, HSCT, SOT, deferoxamine, drug injections, renal failure, infant low birth weight, malnutrition, HIV, SLE, trauma, aplastic anemia & steroid use Dx: skin biopsy taken from center of lesion to subcutaneous fat are likely to show hyphae invading blood vessels of dermis & subcutis Tx cutaneous mucor wide excision & systemic anti fungal amphoB initially (Posaconazole or isavuconazole can be used for step down therapy), some cases had success combing with hyperbaric oxygen - Indiana University Infectious Diseases Fellowship @IUIDfellowship #Cutaneous #Mucormycosis #Eschar #dermatology #skin #clinical #photo
