A Solitary Necrotic Lesion In A Man With Acute Myeloid Leukemia And Neutropenia

A 53-year-old man with acute myeloid leukemia status post chemotherapy was admitted with febrile neutropenia, neutropenic entrocolitis, and stenotrophomonas pneumonia. An inpatient workup revealed central nervous system involvement of his acute myeloid leukemia, and intrathecal chemotherapy was initiated. On hospital day 28, dermatology was consulted for a 7-day history of a painful, progressively enlarging lesion on his left arm. He denied any known history of trauma to the area. Physical examination revealed a 2 centimeter indurated, gray and black plaque with a central vesicle and surrounding erythema on the patient's left upper arm (Figure 1: A). A punch biopsy of the lesion was performed, and tissue was sent for culture and histologic evaluation (Figure 1: B, C, and D). Laboratory evaluation revealed a white blood cell count of 0.1 million cells per microliter. Tissue cultures revealed that the lesion on this patient's arm was a primary cutaneous zygomycosis. The cultures grew Absidia corymbifera, which is in the class Zygomycetes, along with Mucor and Rhizopus.