Cutaneous Mucormycosis: A Fatal Complication of Immunosuppressant Therapy for Pemphigus Vulgaris.

A 62-year-old man with no comorbidities presented to the outpatient department of our Institute with a history of extensive vesiculobullous and erosive skin lesions and oral erosions for 2 months and fever for 1 week. A diagnosis of pemphigus vulgaris was made based on histopathology and direct immunofluorescence of a skin biopsy specimen, and the patient was started on oral prednisolone 40 mg per day along with intravenous antibiotics (amoxicillin-clavulanic acid, gentamicin, and metronidazole) empirically, pending blood and skin swab culture and sensitivity reports. His biochemical and hematologic investigations revealed no abnormalities (hemoglobin 12.4 g/dl, leukocyte count 6500/mm3 , platelet count 250,000/mm3 ), and blood and skin cultures were sterile. When the fever had subsided and while he was receiving antibiotics, he was administered intravenous dexamethasone-cyclophosphamide pulse therapy over 3 days. After this, he was discharged on oral amoxicllin/clavulinc acid 625 mg tid, prednisolone 40 mg daily, and cyclophosphamide 50 mg daily. At the time of discharge, the erosions on the anterior region of the chest were reepithelializing without any evidence of eschar.