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This is one cause of zygomycosis that is a rapidly developing and often fatal infection most common in ketoacidotic diabetics or immunocompromised patients
  • The vasculotropic nature of this organism leads to infarction and necrosis.
  • Epidermal and/or dermal ulceration and necrosis
  • Granulation tissue with sparse inflammation in dermis, often with thrombosis
  • Broad, hollow appearing hyphae with 90 degree branching.
  • Work-Up Considerations:

    • Histologic evaluation of tissue specimen with the aid of special stains for fungi (e.g. PAS, GMS)
    • Part of the specimen can be submitted for frozen tissue processing for more rapid diagnosis.
    • Microscopic examination of tissue scrapings with the aid of KOH or calcofluor may also allow quicker diagnosis than H&E evaluation.
    • Tissue culture studies as well as blood culture.
    • If rhinocerebral disease is suspected, immediate CT scan of paranasal sinuses and endoscopic evaluation of nasal passages should take place.
    • Bronchoalveolar lavage ? biopsy indicated in suspected pulmonary disease.
    • Evaluation of cerebrospinal fluid may be indicated for suspected central nervous system involvement
    • CT scan should be done before lumbar puncture to minimize risk of brain herniation due to procedure.
    • Additional imaging of areas of suspected involvement recommended
    • Also imaging of brain, sinuses, chest, abdomen, and pelvis recommended to evaluate for subclinical disease.

    Treatment:

    • Combination of excision of affected area (including Mohs micrographic surgery) and systemic antifungal therapy (amphotericin B is first line, with posaconazole as second line).
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