Skin mucormycosis presenting as an erythema-nodosum-like rash in a renal transplant recipient: a case report

Abstract

Introduction: Cutaneous mucormycosis is a rare entity related to kidney transplantation. It usually presents with ecthyma-like lesions and black necrotic cellulitis. We report an unusual case of primary cutaneous mucormycosis presenting as erythema-nodosum-like lesions in a woman who had received a renal transplant.

Case presentation: A 49-year-old woman with diabetes received a living-unrelated kidney transplant. Her clinical course was uneventful for the first six months after transplantation. She then developed multiple, painful, erythema-nodosum-like lesions on her right leg and thigh following an episode of minor trauma. Mucormycosis was diagnosed by skin biopsy. Microscopic examination also showed panniculitis. The patient was treated successfully with amphotericin B and surgical resection. To our knowledge, this is the first description of primary cutaneous mucormycosis with erythema-nodosum-like lesions and panniculitis after renal transplantation.

Conclusion: Cutaneous mucormycosis should be considered in the differential diagnosis when a kidney transplant recipient develops erythema-nodosum-like lesions with panniculitis.

Figure 1

Erythema-nodosum-like lesions of the leg and thigh.

Figure 2

Histological section of the skin biopsy showing mucor hyphae in the vessel wall. and necrotic tissue (H&E × 400).

Figure 3

Broad, aseptate and thin walled fungal hyphae having irregular, non-parallel contours, with right angle branching indicative of mucormycosis (PAS × 1000).