Cutaneous Rhizopus infection at a central venous catheter site in a critically ill renal transplant patient

Invasive fungal infections are increasing in incidence, along with the use of immunosuppressive medications for the prevention of organ transplant rejection, graft versus host disease and treatment of auto-immune disorders. Additionally, the incidence of invasive fungal infections is increasing with the use of new antineoplastic therapies for malignancy, increasing incidence of diabetes mellitus, expanded use of broad-spectrum antimicrobial therapy and with an aging population with chronic medical problems such as chronic renal failure, chronic obstructive pulmonary disease and HIV. We present a case of primary cutaneous zygomycosis at the insertion site of a central venous catheter in a 45-year-old renal transplant patient admitted for acute pancreatitis. In the critical care setting, clinicians must retain a high index of suspicion for invasive fungal infections in immunocompromised individuals to ensure early diagnosis and provide aggressive medical and surgical intervention. Liposomal amphoterin B is the first line antimicrobial therapy, and reduction or discontinuation of immunosuppressive therapy should be considered. Currently there are no consensus opinions or recommendations for routine, scheduled replacement of central venous catheters to prevent infections, even in immunosuppressed patients.