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Cutaneous Absidia corymbifera in a Lupus Nephritis Patient
Kuruvilla K Sebastian1, Husam Alzayer1, Elizabeth Abraham2
1Department of Renal Medicine, Cork University Hospital, Cork, IRL.
Cureus
|December 16, 2021
Summary
A farmer with lupus nephritis developed a skin lesion caused by Absidia corymbifera infection. Treatment involved antifungals, reduced immunosuppression, and surgical intervention for this rare fungal complication.
Area of Science:
- Mycology
- Dermatology
- Nephrology
Background:
- Systemic lupus erythematosus (SLE) can lead to lupus nephritis, a severe kidney complication.
- Immunosuppressive therapy is standard for managing lupus nephritis flares.
- Patients on long-term immunosuppression are at increased risk for opportunistic infections.
Observation:
- A 28-year-old farmer with class IV lupus nephritis presented with a fungating, ulcerated, and bleeding right shin lesion.
- The patient had a history of recurrent lupus nephritis flares and was on immunosuppressive induction therapy.
- Differential diagnoses included calciphylaxis, pyoderma gangrenosum, vasculitis, or infection.
Findings:
- Histology and microbiology confirmed the lesion was caused by *Absidia corymbifera*, a rare angioinvasive fungus.
- The patient's kidney function (chronic kidney disease stage IV) was improving with reduced proteinuria on his current regimen.
- *Absidia corymbifera* infection, also known as mucormycosis, is a life-threatening condition.
Implications:
- This case highlights the importance of considering rare fungal infections in immunosuppressed patients with unusual skin lesions.
- Prompt diagnosis and a multi-faceted treatment approach, including antifungals and surgical debridement, are critical for managing *Absidia corymbifera*.
- Careful adjustment of immunosuppressive therapy is necessary to balance disease control and infection risk in lupus nephritis patients.
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