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Primary cutaneous mucormycosis complicating the use of adhesive tape to secure the endotracheal tube

[La mucormycose cutanée primaire nuit à l’usage de ruban adhésif utilisé pour assurer l’immobilité du tube endotrachéal]

From the University Health Network, University of Toronto, Toronto, Ontario, Canada.

Dr. Kerrayem Alsuwaida, University Health Network, University of Toronto, CCRW3-884, 101 College Street, Toronto, Ontario M5G 1L7, Canada. E-mail: alsuwaida{at}sprint.ca

Purpose: To report a rare case of primary cutaneous mucormycosis (PCM), complicating securing of the endotracheal tube with adhesive tape.

Clinical features: 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.

Conclusion: 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.

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