Alsuwaida Kerrayem
University Health Network, University of Toronto, Toronto, Ontario, Canada.
Can J Anaesth. 2002 Oct;49(8):880-2. doi: 10.1007/BF03017426.
To report a rare case of primary cutaneous mucormycosis (PCM), complicating securing of the endotracheal tube with adhesive tape.
A 39-yr-old woman with systemic lupus erythematosus (SLE) developed four annular, punched out ulcers with a necrotic centre and elevated border in a linear distribution over the left cheek, under the tape securing the endotracheal tube. A tissue biopsy revealed broad, branching, nonseptate hyphae found in epidermis and dermis consistent with mucormycosis, best demonstrated with silver staining. Cultures were positive for Rhizopus species. Treatment with iv amphotericin B was successful.
Because of the rarity of the disease and the difficulty of culturing the causative organism, diagnosis of mucormycosis is often elusive. Tissue biopsy and microscopic visualization of nonseptate hyphae with right-angled branching are the only methods for making the diagnosis. Skin biopsy of new ulcerative or plaque-like lesions should be obtained in immunocompromised patients. Early diagnosis and prompt treatment are critical for favourable outcomes in PCM.
报告一例罕见的原发性皮肤毛霉病（PCM），其因气管插管使用胶带固定而并发。
一名39岁的系统性红斑狼疮（SLE）女性患者，在气管插管固定胶带下方的左脸颊出现了四个环形、边界清晰的溃疡，溃疡中心坏死，边界隆起，呈线性分布。组织活检显示，在表皮和真皮中发现了粗大、分支、无隔膜的菌丝，与毛霉病相符，银染色显示最佳。培养结果显示根霉属阳性。静脉注射两性霉素B治疗成功。
由于该病罕见且致病微生物培养困难，毛霉病的诊断往往难以捉摸。组织活检和显微镜下观察到呈直角分支的无隔膜菌丝是确诊的唯一方法。对于免疫功能低下的患者，应获取新出现的溃疡性或斑块状病变的皮肤活检样本。早期诊断和及时治疗对于原发性皮肤毛霉病取得良好预后至关重要。
