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December 2006

Zygomycosis of the Penis Due to Rhizopus oryzae Successfully Treated With Surgical Debridement and a Combination of High-Dose Liposomal and Topical Amphotericin B

Arch Dermatol. 2006;142(12):1650-1666. doi:10.1001/archderm.142.12.1657

Zygomycosis is a rare but life-threatening opportunistic fungal infection occurring mainly in severely immunocompromised patients or patients with diabetes mellitus. The most common location of zygomycosis in patients with diabetes mellitus is rhinocerebral. We describe herein the first case known to us of primary cutaneous zygomycosis due to Rhizopus oryzae located on the penis in a patient with diabetes mellitus and ketoacidosis.

A 52-year-old man was admitted with purulent lesions of the penis. For a few weeks prior to hospitalization, the patient had polyuria and polydipsia. Then gray-black plaques appeared on the glans penis and the prepuce. The diagnosis of zygomycosis was made on direct fungal examination of the necrotizing lesions (Figure 1), and diabetes mellitus with severe ketoacidosis was rapidly diagnosed. The treatment was aggressive to avoid dissemination of the infection. It required management of diabetes mellitus, surgical debridement of the lesions (Figure 2), systemic antifungal therapy with liposomal amphotericin B at doses reaching 7 mg/kg per day for 21 days, and topical amphotericin B application during a 2-month period. The only adverse effect of the medical therapy was diabetes insipidus. No systemic dissemination was observed, and the disease was eradicated within 2 months with no relapse.