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Critical Situations
October 2005

Invasive Zygomycosis With a Fatal Outcome

Arch Dermatol. 2005;141(10):1211-1213. doi:10.1001/archderm.141.10.1211

A previously healthy 24-year-old male Egyptian farmer had nasal obstruction, mucopurulent nasal discharge, recurrent attacks of headache, hyposmia, and a painless nonpruritic erythematous plaque on his nose and adjacent parts of the face and nasal mucosa (Figure 1). The condition had started 12 months earlier as a small erythematous indurated plaque that gradually increased in size to approximately 12 cm in diameter. The lesion was firm, with a well-defined, slightly raised border. A similar plaque about 4 cm in diameter was seen on the lateral aspect of his right thigh. There was no adenopathy. The patient denied any other symptoms, specifically fever, night sweats, or weight loss. Laboratory findings were all within normal range, including those for serum immunoglobulin levels and CD4 and CD8 T-cell counts. The results of a tuberculin test were negative for organisms. Plain x-ray films of the patient’s sinuses (Water’s projection) showed pansinus opacification. Computed tomography of his paranasal sinuses also revealed pansinus opacification with focal areas of hyperdensity. Magnetic resonance imaging of his brain showed multiple space-occupying lesions in the parietal, frontal, and temporal brain lobes (Figure 2).

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