{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T02:33:09Z","timestamp":1778293989191,"version":"3.51.4"},"reference-count":25,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2023,5,9]],"date-time":"2023-05-09T00:00:00Z","timestamp":1683590400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Mucormycosis, caused by the widespread molds of the Mucorales order, is an insidious infection that manifests in different clinical forms. Even the most benign form, the cutaneous mucormycosis, can present with severe complications and a fatal outcome in patients with a suppressed immune system and underlining comorbidities. We present a rare case of a proven primary multifocal cutaneous mucormycosis in a child with newly diagnosed acute leukemia without multiorgan dissemination. Various laboratory techniques (histopathological, cultural and molecular-genetic) were used to detect and confirm the diagnosis. Etiological therapy (liposomal amphotericin B, 5 mg\/kg) combined with surgical intervention were used to manage the infection. The case shows that a rapid and complex diagnostic approach is of crucial importance for the timely initiation of adequate therapy, as well as for the successful management of this life-threatening fungal infection.<\/jats:p>","DOI":"10.3390\/medicina59050905","type":"journal-article","created":{"date-parts":[[2023,5,9]],"date-time":"2023-05-09T03:17:56Z","timestamp":1683602276000},"page":"905","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["A Case of Primary Multifocal Cutaneous Mucormycosis in a Pediatric Patient with Newly Diagnosed Acute Lymphoblastic Leukemia"],"prefix":"10.3390","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3666-3802","authenticated-orcid":false,"given":"Denis","family":"Niyazi","sequence":"first","affiliation":[{"name":"Microbiology Laboratory, University Hospital \u201cSt. Marina\u201d\u2014Varna, 9010 Varna, Bulgaria"},{"name":"Medical University of Varna, Varna 9002, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Milena","family":"Belcheva","sequence":"additional","affiliation":[{"name":"Medical University of Varna, Varna 9002, Bulgaria"},{"name":"Pediatric Hematology and Oncology Clinic, University Hospital \u201cSt. Marina\u201d\u2014Varna, 9010 Varna, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4921-669X","authenticated-orcid":false,"given":"Stoyan","family":"Vergiev","sequence":"additional","affiliation":[{"name":"Department of Ecology and Environmental Protection, Technical University of Varna, 9010 Varna, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valeria","family":"Kaleva","sequence":"additional","affiliation":[{"name":"Medical University of Varna, Varna 9002, Bulgaria"},{"name":"Pediatric Hematology and Oncology Clinic, University Hospital \u201cSt. Marina\u201d\u2014Varna, 9010 Varna, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Temenuga","family":"Stoeva","sequence":"additional","affiliation":[{"name":"Microbiology Laboratory, University Hospital \u201cSt. Marina\u201d\u2014Varna, 9010 Varna, Bulgaria"},{"name":"Medical University of Varna, Varna 9002, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,9]]},"reference":[{"key":"ref_1","first-page":"175","article-title":"Epidemiology and treatment approaches in management of invasive fungal infections","volume":"3","author":"Kriengkauykiat","year":"2011","journal-title":"Clin. Epidemiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1093\/jpids\/pix107","article-title":"Mucormycosis in Children: Review and Recommendations for Management","volume":"7","author":"Francis","year":"2018","journal-title":"J. Pediatric. Infect. Dis. Soc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1007\/BF01932420","article-title":"Mycosis mucorina\u00a0","volume":"102","author":"Paltauf","year":"1885","journal-title":"Virchows Arch."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1001\/jama.1957.02970450007003","article-title":"Mucormycosis; a new disease?","volume":"163","author":"Baker","year":"1957","journal-title":"J. Am. Med. Assoc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"S23","DOI":"10.1093\/cid\/cir866","article-title":"Epidemiology and clinical manifestations of mucormycosis","volume":"54","author":"Petrikkos","year":"2012","journal-title":"Clin. Infect. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"13030","DOI":"10.5070\/D3206022864","article-title":"Primary cutaneous zygomycosis secondary to minor trauma in an immunocompromised pediatric patient: A case report","volume":"20","author":"Sirignano","year":"2014","journal-title":"Dermatol. Online J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1746-1596-5-1","article-title":"Usefulness of molecular biology performed with formaldehyde-fixed paraffin embedded tissue for the diagnosis of combined pulmonary invasive mucormycosis and aspergillosis in an immunocompromised patient","volume":"8","author":"Hofman","year":"2010","journal-title":"Diagn. Pathol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1093\/cid\/ciz1008","article-title":"Revision and Update of the Consensus Definitions of Invasive Fungal Disease from the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium","volume":"71","author":"Donnelly","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1111\/bjh.16329","article-title":"Mucormycosis in children with haematological malignancies is a salvageable disease: A report from the Israeli Study Group of Childhood Leukemia","volume":"189","author":"Elitzur","year":"2020","journal-title":"Br. J. Haematol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Pana, Z.D., Seidel, D., Skiada, A., Groll, A.H., Petrikkos, G., Cornely, O.A., and Roilides, E. (2016). Invasive mucormycosis in children: An epidemiologic study in European and non-European countries based on two registries. BMC Infect. Dis., 16.","DOI":"10.1186\/s12879-016-2005-1"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1138","DOI":"10.1093\/clinids\/27.5.1138","article-title":"The epidemiological features of invasive mycotic infections in the San Francisco Bay area, 1992\u20131993: Results of population-based laboratory active surveillance","volume":"27","author":"Rees","year":"1998","journal-title":"Clin. Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"S93","DOI":"10.1093\/mmy\/myx101","article-title":"Challenges in the diagnosis and treatment of mucormycosis","volume":"56","author":"Skiada","year":"2018","journal-title":"Med. Mycol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"S85","DOI":"10.1111\/myc.12243","article-title":"Mucormycosis in India: Unique features","volume":"57","author":"Chakrabarti","year":"2014","journal-title":"Mycoses"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1007\/s12281-015-0236-z","article-title":"Cutaneous Mucormycosis: Mycological, Clinical, and Therapeutic Aspects","volume":"9","author":"Bonifaz","year":"2015","journal-title":"Curr. Fungal Infect. Rep."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1016\/j.idc.2021.03.009","article-title":"Mucormycosis","volume":"35","author":"Steinbrink","year":"2021","journal-title":"Infect. Dis. Clin. N. Am."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1016\/j.ad.2017.07.020","article-title":"Primary Cutaneous Mucormycosis Due to Rhizopus arrhizus in an 8-Year-Old Girl. Mucormicosis cut\u00e1nea primaria por Rhizopus arrhizus en una ni\u00f1a de 8 a\u00f1os","volume":"109","year":"2018","journal-title":"Actas Dermo-Sifiliogr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1016\/j.ijporl.2013.02.025","article-title":"Cutaneous mucormycosis of nose and facial region in children: A case series","volume":"77","author":"Chakravarti","year":"2013","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1111\/j.1525-1470.2007.00398.x","article-title":"Primary cutaneous zygomycosis in two immunocompromised children","volume":"24","author":"Shin","year":"2007","journal-title":"Pediatr. Dermatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e405","DOI":"10.1016\/S1473-3099(19)30312-3","article-title":"Global guideline for the diagnosis and management of mucormycosis: An initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium","volume":"19","author":"Cornely","year":"2019","journal-title":"Lancet Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e01022","DOI":"10.1016\/j.idcr.2020.e01022","article-title":"Cerebro-rhino-orbital mucormycosis and aspergillosis coinfection in a patient with diabetes mellitus: A case report","volume":"23","author":"Zayet","year":"2020","journal-title":"IDCases"},{"key":"ref_21","first-page":"207","article-title":"Mucormycosis in hematologic patients","volume":"89","author":"Pagano","year":"2004","journal-title":"Haematologica"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Carvalhaes, C.G., Rhomberg, P.R., Huband, M.D., Pfaller, M.A., and Castanheira, M. (2023). Antifungal Activity of Isavuconazole and Comparator Agents against Contemporaneous Mucorales Isolates from USA, Europe, and Asia-Pacific. J. Fungi, 9.","DOI":"10.3390\/jof9020241"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Dagher, H., Hachem, R., Chaftari, A.-M., Jiang, Y., Ali, S., Deeba, R., Shah, S., and Raad, I. (2022). Real-World Use of Isavuconazole as Primary Therapy for Invasive Fungal Infections in High-Risk Patients with Hematologic Malignancy or Stem Cell Transplant. J. Fungi, 8.","DOI":"10.3390\/jof8010074"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1350","DOI":"10.1086\/428780","article-title":"Zygomycosis in a tertiary-care cancer center in the era of Aspergillus-active antifungal therapy: A case-control observational study of 27 recent cases","volume":"191","author":"Kontoyiannis","year":"2005","journal-title":"J. Infect. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Skiada, A., Drogari-Apiranthitou, M., Pavleas, I., Daikou, E., and Petrikkos, G. (2022). Global Cutaneous Mucormycosis: A Systematic Review. J. 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