Septic mucormycosis in acute t-cell leucemia – pathogen detection in skin lesions

Häfliger, Stefanie; Blanc Bühlmann, Andrea Marina; Beltraminelli, Helmut; Blum, Roland (2013). Septic mucormycosis in acute t-cell leucemia – pathogen detection in skin lesions (Unpublished). In: 95. Jahresversammlung der SGDV. Montreux. 19.-21.09.2013.

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We report on a 43-year old patient with an acute
T-Cell Leucemia, currently in Aplasia after Chemotherapy,
showing five targetoid bluish skin lesions.
Due to a three weeks history of septic symptoms he
was under treatment with antibiotics and antifungals.
Multiple septic foci were localized (N. caudatus,
liver, kidneys, lung, spine and right psoas). Microbiology
analyses of various blood cultures and
of the aspirate of the psoas abscess showed initially
negative results. Clinically the skin lesions were suspected
to be of septic or thrombogenic origin. A
5 mm punch biopsy was performed and separated
for microbiological diagnostic and conventional histology.
Surprisingly large fungal agents in mostly intravascular
distribution were seen histologically and
identified as Lichtheimia corymbifera (syn. Absidia
corymbifera) by PCR. Cultures remained negative.
The patient died on the following day.
Lichtheimia corymbifera is a fungus belonging to
the family of mucormycosis. Aspergillosis and mucormycosis
are the most common mold infections
in patients with hematological malignancies, clinically
often indistinguishable. However, the true incidence
of mucormycosis is not known and probably
underestimated because of difficulties in diagnosis.
Mucormycosis typically causes acute, aggressive,
and frequently angioinvasive infections presenting
with solitary local skin necrosis. The fact that the
pathogenic fungus was isolated from a very discrete
skin lesion but was not detected in blood cultures,
and only later in the PCR of the aspirate of the psoas
abscess, makes this case exceptional.

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