Primary Cutaneous Mold Infections in Hematologic Malignancy with a Review of the Literature
Opportunistic fungal infections, namely Aspergillus and Candida, followed by Fusarium, Rhizopus, Mucor, and Alternaria spp are an important cause of morbidity and mortality in patients with hematologic malignancies. Cutaneous mucormysosis infections are extremely rare, and the incidence, survival outcomes, and factors associated with survival within hematologic malignancies are not clear.
We present a case of a neutropenic patient with underlying aplastic anemia who developed primary cutaneous gangrenous mucormycosis following a cat bite. The literature was reviewed for all cases of primary cutaneous fungal infections in immunosuppressed patients reported in the English literature utilizing the PUBMED database from 1980-2012 with the search terms “primary,” “cutaneous,” “fungal,” “infection” and “cancer.” The review yielded 50 cases of primary cutaneous fungal infections in patients with hematologic malignancies with few cases excluded. Survival outcomes were investigated with clinical correlates as to provide a basis for comparison.
In the 51 cases identified, 66.7% were neutropenic upon presentation, and 54.9% were male with an average age of 32 years. Aspergillus spp (33.3%) was the most cited followed by Rhizopus spp (19.6%). Overall mortality rate was 29.4% and was observed more frequently in patients with neutropenia (60%) and without surgical intervention (73.3%). Survival rate was higher (35.3%) for cases utilizing both antifungal and surgical intervention. The antifungal with the highest survival rate was amphotericin B and its formulations (58.8%).
Neutropenia within hematologic malignancies demonstrate a risk for developing severe cutaneous fungal infections of which primary cutaneous mucormycosis can carry significant mortality. Combination antifungal therapy and surgical debridement appears be associated with higher survival outcomes and warrants further investigation.
K. Soni, None
L. Mojica, None
J. Morano, None
J. Greene, None
R. Sandin, None