Cutaneous Mucormycosis of the Thoracic Wall

We report a case of cutaneous mucormycosis in a patient with diabetes. A 72-year-old male with a history of diabetes mellitus underwent repeated coronary artery bypass surgery. During the second postoperative week, an ulcer with necrotic edges appeared at the site of a thoracic drain. This ulcer was originally 2 x 2 cm, but its size increased rapidly. Culture of initial swab specimens failed to yield any microorganisms. Three weeks later, blood cultures were found to be positive for Candida albicans, at the same time, a white, filamentous material was noted around the edges of the ulcer. Biopsy specimens were sent for microbiological and pathological analysis. Culture of this material yielded C. albicans and a filamentous fungus, later identified as Rhizopus oryzae. Both fungi were also demonstrated histologically. Emergent wide surgical excision was carried out, and immediately thereafter amphotericin B was administered intravenously (120 mg/d) and topically. The patient's cardiac output remained low, and he died of multiorgan failure 2 days later.