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Necrotizing panniculitis secondary to primary cutaneous localized mucormycosis


Journal of Dermatology & Cosmetology
P Chicharro,1 E Gallo,1 E Daudén,1 J Fraga,2 M Llamas Velasco1

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Abstract

Primary cutaneous mucormycosis is a rare entity that affects more frequently extremities of immunosuppressed patients and may be gradual in onset or fulminant.
 
An 83-year-old female with diabetes mellitus presented a nodular lesion in the forearm, which had progressedduringone month. Clinically, as the lesion was indolent and followed a linear trajectory, a superficial phlebitis was suspected but later ruled out. Skin blood cultures were negative. Skin biopsy showed a necrotic panniculitis with isolated ghost adipocytes and presence of irregularly branched hyphae involving dermis and some vesselsthat could be stained with PAS and Grocott, , thus leading to the diagnosis of primary cutaneous localized mucormycosis. This case is noteworthy as indolent course in primary cutaneous mucormycosis with vascular involvement is rather rare. Even with a negative culture,R. variabilisis acandidateetiologic agent as it usually presents a chronic evolution. Histopathologically, most panniculitis related to fungal infection are reportedas pancreatic panniculitis mimickers. In our case, only scarce ghost adipocytes were found and the main histopathological findings were a lobular panniculitis with vasculitis and an extensive basophilic necrosis. Thus, these histopathologic findings should raise suspicion of infection related-panniculitis, and PAS and Grocottstainings should be performed to rule out fungi.

Keywords

mucormycosis, diabetes mellitus, diabetes complications, panniculitis, thrombophlebitis, necrotic panniculitis, vascularization,

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