Case #13:

Clinical Presentation:
A 40-year-old liver transplant presents with an ulcerated skin lesion at the site of an intravenous line (Case 13 Image 1). The lesion began as an erythematous macular-papular lesion and progressed to a black, necrotic ulcer. The patient did not have evidence of systemic disease.

Clinical Diagnoses:
Ecthyma Gangrenosum
Fungal Skin Lesion
Vasculitis

Case 13 Image 2: Giemsa stain of tissue from ulcer scraping demonstrating broad non-septate hyphae.
Case 13 Image 3: Direct wet-preparation of tissue scrapings showing ribbon like, branching, non-septate hypae.

Discussion:
Microbiologic Diagnosis:
IV Site Mucormycosis (Rhizopus species)
This opportunistic, saprophytic mold can contaminate bandages and dressings, resulting in a necrotizing soft-tissue infection via angioinvasion and infarction. Dissemination from the site can occur. Surgical debridement is an important adjunct to antifungal therapy.