Cutaneous zygomycosis in a diabetic HTLV-I-seropositive man.

Abstract

Zygomycosis, an invasive fungal infection, is usually seen in persons with diabetes, particularly in those with diabetic ketoacidosis. The infection most frequently occurs in the rhinocerebral region and rapidly spreads, causing a swift demise. Rarely, the infection is confined to the cutaneous tissues. We describe a 31-year-old man seropositive for human T lymphotropic virus type I who had diabetic ketoacidosis with zygomycosis confined to the right arm. The lesion was presumed initially to be a bacterial infection but did not respond to conventional antimicrobial therapy. The arm lesion was cultured, and Rhizopus arrhizus was isolated. The patient responded well to a combination of amphotericin B and extensive surgical debridements. Our case emphasizes the importance of maintaining a high index of suspicion of cutaneous zygomycotic infections in the impaired host, especially of those in patients with diabetes, who do not respond to initial antimicrobial treatment.