[A case of mucormycosis of the thoracic wall in a non-immunocompromised man]

An 80-year-old man visited our hospital for the treatment of an anterior chest wall eruption from February 2007 and presented with dull pain in August 2007. He was referred to our department because chest CT showed the formation of an abscess from the subcutaneous area to the thoracic wall. Histological findings obtained from CT-guided biopsy revealed epithelioid granuloma without caseous necrosis, but both acid-fast bacteria and bacteriologic culture obtained from aspirated fluid samples were negative. Antituberculous therapy was selected because a tuberculous abscess was strongly suspected. However, the patient discontinued treatment soon after therapy began. He visited our hospital again for chest pain due to rupture of the abscess in October 2007. The pathological findings obtained from a second biopsy gave the same results, and antituberculosis therapy was restarted. However, his CT findings had worsened by August 2008, and a third biopsy was performed. Histopathologically, we diagnosed mucormycosis based on the findings of fungal hyphae, with broad, irregular branching at right angles. Thereafter, liposomal amphotericin B (L-AMB) was given intravenously and the abscess markedly improved. Excision was then performed, followed by adjuvant L-AMB administration, and there has been no recurrence to date.