Disseminated zygomycosis heralded by a subtle cutaneous finding

Zygomycosis is the preferred name for the angiotropic infection produced by the Zygomycete class of fungi. Although healthy individuals may be affected, the majority of patients diagnosed with zygomycosis have diabetes, malignancy, or have had solid organ or bone marrow transplantation. Unlike other filamentous fungi that tend to disseminate hematogenously to skin, cutaneous zygomycosis most commonly arises via direct inoculation. Cutaneous lesions of zygomycosis are characteristically hemorrhagic, ulcerated or necrotic plaques. Histology typically demonstrates angioinvasion with associated necrosis.

We present a case of a neutropenic patient who presented with disseminated zygomycosis heralded by a clinically non-specific erythematous macule that showed non-specific, mild, inflammatory changes on histological examination. Tissue culture was performed at the time of initial evaluation and was consistent with zygomycosis. Rhizomucor was subsequently confirmed by PCR. The patient was diagnosed with disseminated zygomycosis, treatment was promptly initiated, and the patient recovered completely. Our case represents an atypical clinical and histological presentation of disseminated zygomycosis and highlights the value of performing tissue culture of non-distinctive cutaneous lesions, especially in the setting of severely immunocompromised states.