Paul Persad, MD; Elizabeth Palavecino, MD
A 51-year-old man with a past medical history of end stage
renal disease (ESRD) secondary to Goodpasture's disease, diabetes mellitus,
hyperlipidemia and hypertension was transferred to our facility from an outside
hospital for fever and gangrenous changes to his middle and ring fingers. His medical regimen included cyclophosphamide
The patient stated that he injured his right hand while
cutting his lawn. Over the next 3 days
he noted worsening pain, paresthesia, discoloration then numbness that spread
from the tips to the base of the middle and ring fingers. He reported fevers
over 101 F. Despite broad spectrum
antibiotics, including vancomycin and piperacillin/tazobactam, amputation of
the involved fingers was necessary.
Pathologic evaluation of the surgical specimens revealed
gangrenous necrosis of the digits with
angioinvasive fungal elements seen with H&E stain (Figure 1 and 2).
A Gomori methenamine silver (GMS) stain revealed numerous branching hyphae
(Figure 3). The morphology of the
organism recovered in culture allowed the identification of the fungal organism
causing the infection (Figure 4).
What organism is most likely pathogenic in this situation?
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