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&#62;<span class="elsevierStyleHsp" style=""></span>16<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL for caspofungin&#44; and 0&#46;03<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL for terbinafine&#46; No accumulation of liquid or gas was observed on ultrasound&#46; The ulcer started to heal after treatment with amphotericin B 100<span class="elsevierStyleHsp" style=""></span>mg daily for 10 days combined with surgical debridement of the wound&#46; Re-epithelization occurred 3 months after topical application of silver sulfadiazine &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Fungi of the order Mucorales are ubiquitous in nature&#44; and can be found in soil&#44; organic substrates &#40;wood&#44; fruit&#44; excrements&#44; etc&#46;&#41; or as pathogens in animals and plants&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Approximately 70&#37; to 80&#37; of Mucorales infections in humans are caused by <span class="elsevierStyleItalic">Rhizopus</span>&#44; <span class="elsevierStyleItalic">Mucor</span>&#44; or <span class="elsevierStyleItalic">Lichtheimia</span> genera and tend to affect immunodepressed individuals&#46; Infections progress fast&#44; do not respond to standard antifungals&#44; and have high morbidity and mortality&#46; The remaining 20&#37; to 30&#37; of cases are caused by the rarer genera <span class="elsevierStyleItalic">Cunninghamella&#44; Rhizomucor</span>&#44; <span class="elsevierStyleItalic">Saksenaea</span>&#44; <span class="elsevierStyleItalic">Apophysomyces&#44; Syncephalastrum&#44; Cokeromyces</span>&#44; and <span class="elsevierStyleItalic">Actinomucor&#46;</span> Infections in these cases tend to run a benign course&#44; with exclusive skin and subcutaneous tissue involvement&#46; They are associated with low mortality and respond well to amphotericin B and azoles&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Infections due to <span class="elsevierStyleItalic">S&#160;vasiformis</span> have been reported worldwide&#44; although most cases have been described in the United States&#44; Central America&#44; Brazil&#44; Europe&#44; India&#44; and Australia&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> In our search of PubMed&#44; we found 6 cases of <span class="elsevierStyleItalic">S vasiformis</span> infection reported for Spain&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#8211;8</span></a> One of these was in the same area as our hospital&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> and they all occurred in adults aged over 45 years &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; In most of the cases&#44; the fungus had penetrated the skin following an accident involving contact with soil&#46; The cases involving local cutaneous involvement were resolved by administration of specific treatment or amputation of the affected limb&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;4</span></a> The patients with noncutaneous forms of <span class="elsevierStyleItalic">S&#160;vasiformis</span> infection forms died regardless of their underlying immune status&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">These opportunistic fungi gain entry through injuries or wounds caused by trauma&#44; with most cases involving major trauma&#44; such as traffic accidents&#44; farming accidents &#40;wound contamination&#41; and surgery&#46; There have&#44; however&#44; also been descriptions of infections by Mucorales fungi following minor trauma&#44; including bites and stings&#46; There have been reports of <span class="elsevierStyleItalic">S vasiformis</span> infection in a patient pecked by a magpie<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> and stung by a scorpion&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> The first case was resolved by wound debridement and administration of amphotericin B&#44; although a skin graft was required to repair the wound defect&#46; In the second case&#44; amputation of the affected leg was necessary&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Infections due to <span class="elsevierStyleItalic">S vasiforms</span> are probably underdiagnosed as these fungi do not easily produce spores in standard fungal media&#46; A high index of clinical suspicion is therefore necessary to ensure early treatment and avoid amputations and fatal outcomes&#46;</p></span>"
    "pdfFichero" => "main.pdf"
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      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Coronel-P&#233;rez I&#44; Rodr&#237;guez-Rey E&#44; Castilla-Guerra L&#44; Dom&#237;nguez M&#46; Mucormicosis cut&#225;nea primaria por <span class="elsevierStyleItalic">Saksenaea vasiformis</span> en paciente inmunocompetente&#46; Actas Dermosifiliogr&#46; 2015&#59;106&#58;516&#8211;518&#46;</p>"
      ]
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      0 => array:7 [
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Necrotic 5-cm ulcer surrounded by friable tissue&#44; areas with a lumpy cotton-like appearance&#44; and swelling of the forearm and dorsum of the left hand&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Forearm 3 months later&#46; The ulcer had almost completely re-epithelialized following treatment with amphotericin B&#44; surgical debridement of the wound&#44; and topical application of silver sulfadiazine&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Reference&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sex&#47;Age&#44; y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mechanism of Infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Presentation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Immune Status&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Outcome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Cefai et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> 1987&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Woman&#47;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fall with elbow fracture&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Gangrenous cellulitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Resolution after amputation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">G&#243;mez Merino et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> 2003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Man&#47;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cranioencephalic trauma due to traffic accident&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cellulitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Immunocompetent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Resolution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Garc&#237;a Mart&#237;nez et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> 2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Man&#47;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Possible inhalation of spores &#40;gardener&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Invasive rhinocerebral mucormycosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Immunodepressed &#40;diabetes&#44; metastatic gastric adenocarcinoma&#44; corticosteroid therapy&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Death&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Dom&#237;nguez et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> 2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Woman&#47;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Unknown&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Disseminated infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Immunocompetent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Death&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Mayayo et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> 2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Woman&#47;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Traffic accident&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Necrotizing fasciitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Immunocompetent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Death&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">G&#243;mez Camarasa et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> 2014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Man&#47;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Farm accident&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cutaneous mucormycosis with subsequent dissemination&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Immunodepressed &#40;diabetes&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Death&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Present case&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Man&#47;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bite&#47;sting of unknown origin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cellulitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Immunocompetent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Published Cases of <span class="elsevierStyleItalic">Saksenaea vasiformis</span> Infection in Spain&#46;</p>"
        ]
      ]
    ]
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Vol. 106. Núm. 6.
Páginas 516-518 (julio - agosto 2015)
Vol. 106. Núm. 6.
Páginas 516-518 (julio - agosto 2015)
Case and Research Letters
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Primary Cutaneous Mucormycosis Due to Saksenaea vasiformis in an Immunocompetent Patient
Mucormicosis cutánea primaria por Saksenaea vasiformis en paciente inmunocompetente
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I.M. Coronel-Péreza,
Autor para correspondencia
mcoronel@aedv.es

Corresponding author.
, E.M. Rodríguez-Reya, L. Castilla-Guerrab, M.C. Domínguezc
a Servicio de Dermatología, Hospital de la Merced, Área de Gestión Sanitaria de Osuna, Sevilla, Spain
b Servicio de Medicina Interna, Hospital de la Merced, Área de Gestión Sanitaria de Osuna, Sevilla, Spain
c Servicio de Microbiología, Hospital de la Merced, Área de Gestión Sanitaria de Osuna, Sevilla, Spain
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Table 1. Published Cases of Saksenaea vasiformis Infection in Spain.
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A 76-year-old man with a history of hypertension, dyslipidemia, and cerebral vascular accident presented with a necrotic lesion and intense inflammation of the surrounding soft tissues on the left forearm. He attributed the lesion to a sting or bite of unknown origin during a hunting outing in the month of July. The ulcer worsened despite treatment with oral doxycycline and intravenous amoxicillin-clavulanic acid, and the patient was administered intravenous broad-spectrum empiric antibiotic therapy with imipenem and amphotericin B (Fig. 1). Hematoxylin-eosin staining of a biopsy specimen showed branching hyphae in the subcutaneous tissue together with necrosis and an intense inflammatory infiltrate. Cultures were negative for aerobic and anaerobic bacteria and mycobacteria. Fungal culture in Sabouraud-dextrose agar permitted the identification of the microorganism responsible for the infection after 48hours incubation at 30°C. Microscopic examination with lactophenol cotton blue revealed the growth of a white downy colony, without sporulation, in addition to typical wide, aseptate hyphae with right-angle branching characteristic of Mucorales fungi. The strain was sent to the Mycology Laboratory at Instituto de Salud Carlos III, where it was identified as Saksenaea vasiformis with a minimum inhibitory concentration of 2μg/mL for amphotericin B, >8μg/mL for itraconazole and voriconazole, 2μg/mL for posaconazole; >16μg/mL for caspofungin, and 0.03μg/mL for terbinafine. No accumulation of liquid or gas was observed on ultrasound. The ulcer started to heal after treatment with amphotericin B 100mg daily for 10 days combined with surgical debridement of the wound. Re-epithelization occurred 3 months after topical application of silver sulfadiazine (Fig. 2).

Figure 1.

Necrotic 5-cm ulcer surrounded by friable tissue, areas with a lumpy cotton-like appearance, and swelling of the forearm and dorsum of the left hand.

(0.1MB).
Figure 2.

Forearm 3 months later. The ulcer had almost completely re-epithelialized following treatment with amphotericin B, surgical debridement of the wound, and topical application of silver sulfadiazine.

(0.11MB).

Fungi of the order Mucorales are ubiquitous in nature, and can be found in soil, organic substrates (wood, fruit, excrements, etc.) or as pathogens in animals and plants.1 Approximately 70% to 80% of Mucorales infections in humans are caused by Rhizopus, Mucor, or Lichtheimia genera and tend to affect immunodepressed individuals. Infections progress fast, do not respond to standard antifungals, and have high morbidity and mortality. The remaining 20% to 30% of cases are caused by the rarer genera Cunninghamella, Rhizomucor, Saksenaea, Apophysomyces, Syncephalastrum, Cokeromyces, and Actinomucor. Infections in these cases tend to run a benign course, with exclusive skin and subcutaneous tissue involvement. They are associated with low mortality and respond well to amphotericin B and azoles.2

Infections due to S vasiformis have been reported worldwide, although most cases have been described in the United States, Central America, Brazil, Europe, India, and Australia.2 In our search of PubMed, we found 6 cases of S vasiformis infection reported for Spain.3–8 One of these was in the same area as our hospital,6 and they all occurred in adults aged over 45 years (Table 1). In most of the cases, the fungus had penetrated the skin following an accident involving contact with soil. The cases involving local cutaneous involvement were resolved by administration of specific treatment or amputation of the affected limb.3,4 The patients with noncutaneous forms of S vasiformis infection forms died regardless of their underlying immune status.

Table 1.

Published Cases of Saksenaea vasiformis Infection in Spain.

Reference  Sex/Age, y  Mechanism of Infection  Presentation  Immune Status  Outcome 
Cefai et al.,3 1987  Woman/55  Fall with elbow fracture  Gangrenous cellulitis  Not specified  Resolution after amputation 
Gómez Merino et al.,4 2003  Man/66  Cranioencephalic trauma due to traffic accident  Cellulitis  Immunocompetent  Resolution 
García Martínez et al.,5 2008  Man/71  Possible inhalation of spores (gardener)  Invasive rhinocerebral mucormycosis  Immunodepressed (diabetes, metastatic gastric adenocarcinoma, corticosteroid therapy)  Death 
Domínguez et al.,6 2012  Woman/82  Unknown  Disseminated infection  Immunocompetent  Death 
Mayayo et al.,7 2013  Woman/46  Traffic accident  Necrotizing fasciitis  Immunocompetent  Death 
Gómez Camarasa et al.,8 2014  Man/58  Farm accident  Cutaneous mucormycosis with subsequent dissemination  Immunodepressed (diabetes)  Death 
Present case  Man/76  Bite/sting of unknown origin  Cellulitis  Immunocompetent  Cure 

These opportunistic fungi gain entry through injuries or wounds caused by trauma, with most cases involving major trauma, such as traffic accidents, farming accidents (wound contamination) and surgery. There have, however, also been descriptions of infections by Mucorales fungi following minor trauma, including bites and stings. There have been reports of S vasiformis infection in a patient pecked by a magpie9 and stung by a scorpion.10 The first case was resolved by wound debridement and administration of amphotericin B, although a skin graft was required to repair the wound defect. In the second case, amputation of the affected leg was necessary.

Infections due to S vasiforms are probably underdiagnosed as these fungi do not easily produce spores in standard fungal media. A high index of clinical suspicion is therefore necessary to ensure early treatment and avoid amputations and fatal outcomes.

References
[1]
A. Skiada, D. Rigopoulos, G. Larios, G. Petrikkos, A. Katsambas.
Global epidemiology of cutaneous zygomycosis.
Clin Dermatol, 30 (2012), pp. 628-632
[2]
M.Z.R. Gomes, R.E. Lewis, D.P. Kontoyiannis.
Mucormycosis caused by unusual mucormycetes, non-Rhyzopus, -Mucor and Lichtheimia species.
Clin Microbiol Rev, 24 (2011), pp. 411-445
[3]
C. Cefai, T.S.J. Elliot, R.W. Nutton, A.E. Lockett, J. Pooley.
Zygomycetic gangrenous cellulitis.
Lancet, 330 (1987), pp. 1337-1338
[4]
E. Gómez Merino, J.J. Blanch Sancho, L. Iñiguez de Onzoño, I. Terrancle Juan, F. Mateos Rodríguez, J. Solera Santos, et al.
Lesión necrótica en cuero cabelludo tras traumatismo.
Rev Clin Esp, 203 (2003), pp. 451-452
[5]
J. García-Martínez, F. López-Medrano, A. Alhambra, A. del Palacio.
Rhinocerebral zygomycosis caused by Saksenae vasiformis in a diabetic patient.
[6]
M.C. Domínguez, J. Sánchez, E. Carmona, S. Vergara-López.
Paciente anciana con lesiones cutáneas de rápida progresión.
Enferm Infecc Microbiol Clin, 30 (2012), pp. 43-45
[7]
E. Mayayo, A.M. Stchigel, J.F. Cano, X. Bernal-Escoté, J. Guarro.
Fascitis necrotizante por Saksenaea vasiformis en una paciente inmunocompetente tras un accidente de tráfico.
Rev Iberoam Micol, 30 (2013), pp. 57-60
[8]
C. Gómez Camarasa, M.D. Rojo-Martín, C. Miranda-Casas, A. Alastruey-Izquierdo, L. Aliaga-Martínez, J.M. Labrador-Molina, et al.
Disseminated infection due to Saksenaea vasiformis secondary to cutaneous mucormycosis.
Mycopathologia, 177 (2014), pp. 97-101
[9]
P.A. Wilson.
Zygomycosis due to Saksenaea vasiformis caused by a Magpie peck.
Med J Austr, 189 (2008), pp. 521-522
[10]
P. Lechevalier, D.G. Hermoso, A. Carol, S. Bonacorsi, L. Ferkdadji, F. Fitoussi, et al.
Molecular diagnosis of Saksenaea vasiformis cutaneous infection after scorpion sting in an immunocompetent adolescent.
J Clin Microbiol, 46 (2008), pp. 3169-3172

Please cite this article as: Coronel-Pérez I, Rodríguez-Rey E, Castilla-Guerra L, Domínguez M. Mucormicosis cutánea primaria por Saksenaea vasiformis en paciente inmunocompetente. Actas Dermosifiliogr. 2015;106:516–518.

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