PMC6883305_01
Necrotizing fasciitis at flexor aspect of right leg. 1A: Extensive necrosis of skin, subcutaneous tissue, fascia and muscles. 1B: Gross appearance of excised tissue (day +21) showing white cottony filamentous growth over the surface.
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A clinical diagnosis of necrotizing fasciitis following infected first degree thermal burn was made (Fig. 1A). Gross examination of the tissue showed white cottony filamentous growth over the surface (Fig. 1B).
Direct microscopy of excised tissue specimen. 2A: Arrows showing coenocytic broad aseptate fungal hyphae in 20% potassium hydroxide mount (x 400). 2B: Calcofluor white staining showing broad aspetate fungal hyphae suggestive of mucoraceous mould (x 400).
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Direct (saline and 20% potassium hydroxide) mount and calcofluor white staining of the tissue showed broad, aseptate fungal hyphae with right angle branching resembling those of a mucoraceous mould (Fig. 2A & B).
Colony morphology of Apophysomyces variabilis on SDA showing white cottony growth with aerial mycelia filling-up the tube and without any pigment on obverse and reverse.
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The SDA tubes at both the temperatures showed profusely growing, white cottony mould with scarce aerial mycelia without any pigment on obverse and reverse after 72 h of incubation (Fig. 3).
Microscopic morphology of Apophysomyces variablis in LPCB mount. 4A: Presence of foot cell, sporangiophore (upto 400 mum long), pigmented subapical thickening, funnel-shaped apophysis and pear-shaped multispored sporangium (x 400). 4B: Arrows showing smooth-walled, subhyaline sporangiospores of variable shape (x 400).
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There was prominent pigmented subapical thickening below the apophyses (Fig. 4A). Sporangiospores were smooth-walled, variable in shape, trapezoid, ellipsoidal, subtriangular or claviform, and subhyaline to light brown in mass (Fig. 4B).