PMC8065302_01
Histopathology sections showing A. 10x magnification H and E epidermal ulceration and granulation tissue. B. 40X magnification ribbon like organisms amid inflammation. C. 40x magnification mucicarmine stain with organism. D. 40X, PAS stain with arrow pointing to organism. E. 40X, GMS stain.
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Several stains were completed, including gram, acid-fast bacilli (AFB), mucicarmine, and Periodic acid-Schiff (PAS), showing ribbon-like pauciseptate hyphae suggestive of Mucorales (Fig. 1). Of note, gram stains were weakly PAS positive, and slides were reviewed by two pathologists: Mayo Clinic (Rochester, MN) and UnityPoint (Des Moines, Iowa) (Fig. 1).
Temporal representation of right forearm lesion. A. Day of presentation. B. One week from initial presentation. C. One month from initial presentation. D. Two months from initial presentation. E. Six months from initial presentation. (Please use color).
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Initial examination showed a 4.0 x 2.5 cm erythematous, heme-crusted plaque of non-healing tissue (Fig. 2A). By hospital day 7, wound healing was noted (Fig. 2B) and ibrutinib was held. At 6-month reevaluation, the patient's lesion had completely healed and he denied any new lesions or symptoms (Fig. 2E).