Review of the Rare Case of Skin and Nail Mucormycosis

Abstract

On June 6 1959, a 17-year-old boy was first seen complaining of a granulomatous ulcer on his left dorsal foot. He had received antituberculous chemotherapy, antibiotics and also corticosteroids for arthritis during past 1 year and a half. From this primary lesion, broad non-septate hyphae were demonstrated microscopically in smear, and a kind of “Mucoraceae” grew on Sabouraud's agar on culture. However, these data were neglected because this fungus was considered to be a saprophyte.
Four weeks after his first examination, numerous dull-red small papules, hemorrhagic vesicles and pustules were seen on his legs. They were generalized soon being accompanied by high fever. At the end of July 1959, numerous thick crusted rupia-like lesions appeared on the extremities and then these lesions eroded in August 1959. In September, all the toe nails were affected and fell out one month later, followed by same lesion of finger nails in October 1959. During those times, the same fungi were isolated from skin and nail lesions repeatedly and abundantly.
The strain isolated was identified as Absidia ramosa by Dr. K. Tsubaki. Further-more, a serum antibody titer against the cell body antigen revealed 1:160 (August 1959) and 1:2560 (Jan. 1960) in complement fixation test. This high titer of serum antibody decreased soon paralleling the improvement of the clinical symptoms to 1:40 (April and August 1960). Intracutaneous test against the same antigen was strongly positive in immediate (15m) and delayed (48hrs) reaction, followed by eczematous delayed reaction 25 days after injection. It was very interesting that the intracutaneous test revealed positive even 5 years after recovery.
The patient was healed 1 year and 8 months after the onset of the primary lesion with residual pigmentation. No recurrence was observed until 1977.