PMC6172532_01
Skin appearance and computed tomography findings of oral mucormycosis. A black necrotic area progressively enlarged on day+15 (A) and day+24 (B) after transplantation. Computed tomography showed swelling of the oral mucosa and lower jaw skin that rapidly progressed on day+18 (C) and day+20 (D).
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Dermatitis progressed rapidly despite treatments with 5 different antibiotics, and his general condition deteriorated (Fig. 1A and B). Computed tomography revealed edematous changes in the larynx and pharynx, and subcutaneous swelling from the left cheek to the neck (Fig. 1C and D).
Pathological findings and a tissue culture of oral mucormycosis. A skin biopsy specimen was completely necrotic, with a surface that was covered by non-septate hyphae with branching at wide angles [Hematoxylin and Eosin (H&E) staining, 100x] (A). Hyphae infiltrated the vessels and surrounding subcutaneous tissue (H&E staining, 200x) (B). Grocott's methenamine silver stain revealed the presence of fungal hyphae (400x) (C). A skin culture grew Mucor spp. (D).
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A skin biopsy on day +24 showed that the necrotic surface layer was covered with non-septate hyphae with branching at wide angles (Fig. 2A-C). Fungal cultures revealed broad hyphae with very few septa that produced long sporangiospores terminating with a dark and round sporangium (Fig. 2D).
The clinical course from the initiation of low-dose Ara-C to post-transplantation. The intensity and duration of neutropenia persisted before and after allo-HSCT, and the c-D-index exceeded 5,800 (i.e., the cut-off point of the c-D-index to estimate the risk of mold infection, mainly aspergillosis) on day+4 after allo-HSCT. Fever with oral mucositis developed on day+6, and a black necrotic area due to mucormycosis was identified on day+15. L-AMB: liposomal amphotericin B, CPFG: caspofungin, MCFG: micafungin, TBI: total body irradiation, Ara-C: cytosine arabinose, uCBT: unrelated cord blood transplantation, WBC: white blood cell, allo-HSCT: allogeneic stem cell transplantation, c-D-index: cumulative D-index
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The patient was treated with L-AMB for 7 days, but died on day +31 after allo-HSCT (Fig. 3).