Document Detail


Cutaneous zygomycosis following attempted radial artery cannulation.
MedLine Citation:
PMID:  15538083     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
A 70-year-old man was seen in a hospital consultation for evaluation of cellulitis of the left arm. The patient had multiple medical problems, including advanced liver disease due to alcohol, diabetes mellitus, congestive heart failure, atrial fibrillation, chronic renal in sufficiency, and hypopituitarism requiring steroid replacement. Most recently, he was admitted to the intensive care unit, where he required intubation and mechanical ventilation support following respiratory failure secondary to pneumonia. At that time, an attempt was also made to place an arterial line in the left radial artery. The patient had multiple areas of ecchymosis on both arms. A large bulla was found on the lateral aspect of the left wrist several days after the attempted arterial line placement. Subsequently, the lesion drained serosanguineous fluid, and, during the next 2 days, it ulcerated with necrosis extending around the wrist and to the elbow. He was started on ampicillin/sulbactam and clindamycin for presumed necrotizing fasciitis. The surgical service performed a very limited debridement,which was partially limited by his coagulopathy from liver disease. The initial tissue culture was positive only for Enterococcus faecium. At the time of the consultation, his temperature was 95' F (35 degrees C), pulse 82 bpm, respirations 16 BPM, and blood pressure 101/56 mmHg. He was awake but not oriented or responsive. His cardiopulmonary exam was unremarkable. Abdominal exam disclosed ascites. His extremities were all grossly edematous with multiple ecchymoses. His left forearm had a circumferential area of ecchymosis and necrosis with macerated margins, sparing only the lateral ulnar epicondyle, and involving deeper structures of subcutaneous fat and muscle(Figures 1-2 showing evolution of the lesion in a period of 1 week). Small tissue clippings were taken from the edge of the lesion and placed on culture plates. By the next morning, the patient's tissue culture grew a mold, later identified as Rhizopus. Amphotericin B was initiated. Surgical intervention (wide debridement with potential conversion to amputation of the left arm) was considered to offer little benefit in view of the patient's multiple and severe comorbidities and his poor prognosis. Amphotericin B was then stopped; the patient died within a week from his multiple medical complications. The family refused an autopsy.
Authors:
Shefali Kapadia; Hari Polenakovik
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Skinmed     Volume:  3     ISSN:  1540-9740     ISO Abbreviation:  Skinmed     Publication Date:    2004 Nov-Dec
Date Detail:
Created Date:  2004-11-11     Completed Date:  2005-02-10     Revised Date:  2009-11-03    
Medline Journal Info:
Nlm Unique ID:  101168327     Medline TA:  Skinmed     Country:  United States    
Other Details:
Languages:  eng     Pagination:  336-8     Citation Subset:  IM    
Affiliation:
Dayton Veterans Affairs Medical Center, Wright State University School of Medicine, OH, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Amphotericin B / therapeutic use
Catheterization, Peripheral / adverse effects*,  methods
Combined Modality Therapy
Debridement
Disease Progression
Fatal Outcome
Humans
Male
Radial Artery*
Risk Assessment
Severity of Illness Index
Zygomycosis / diagnosis*,  etiology,  therapy*
Chemical
Reg. No./Substance:
1397-89-3/Amphotericin B

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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