Phycomycotic gangrenous cellulitis. A report of two cases and a review of the literature
C. B. Wilson, G. R. Siber, T. F. O'Brien and A. P. Morgan
Progressive gangrenous cellulitis due to Rhizopus arrhizus following
colostomy destroyed the entire abdominal wall of a young woman and caused
her death. A similar infection in an 11-year-old kidney transplant
recipient was diagnosed more promptly and treated successfully with
extensive debridement and amphotericin B. Nine similar cases found in the
literature were reviewed. All 11 patients appeared to have had prior tissue
injury at the original site of infection, and seven had diabetes mellitus.
The disease was initially misdiagnosed in most of the patients, progressed
rapidly in eight, and was fatal in four. Phycomycotic gangrenous cellulitis
should be included in the differential diagnosis of progressive necrotizing
lesions of the skin, especially in diabetic patients, but it can be
identified promptly only by histologic examination of the infected tissue.
Urgent radical excision and amphotericin therapy are recommended.
