MEDICAL MYCOLOGY

Dr Tadayo Hashimoto M.D.
Professor
Department of Microbiology & Immunology

25. A 65-year-old female patient is admitted to an intensive care unit because of a sudden swelling of the right side of the face and an episode of bleeding from the right nostril. According to her daughter, these signs were not apparent a few days ago. She has a long history of diabetes and high blood pressure and recently developed clinical signs of ketoacidosis and renal insufficiency. Her blood sugar level at the time of admission is 700 mg/dL. The facial lesion becomes partially necrotic and shows slight protrusion of the right eye and facial paralysis. The patient dies on the second day. Histopathologic examination of the lesions reveals occlusion of small vessels and the presence of non-septate hyphae. This is most probably caused by:

candidiasis
nocardiosis
mucormycosis
erysipelas
gas gangrene

(C) This description is a typical clinical picture of mucormycosis occurring in a diabetic patient. Mucor is a member of Phycomycetes, which forms uniseptate hyphae. In candidiasis, septate hyphae and budding yeast are seen in infected tissues. Nocardiosis, erysipelas, and gas gangrene are not mycotic infections. They are caused by bacteria (Nocardia asteroides, Streptococcus pyogenes, and Clostridium perfringens respectively). (Joklik et al, pp. 1151-1152)

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