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Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing 210042, China

A five-year-old girl was admitted to our institute for the skin lesions on the face for about 6 months. She was injured in May 2003, radiography and CT demonstrated fracture of her nasal bone, and reposition of the nasal bone was performed in a local hospital. The skin lesions began with reddish papules 20 days after the operation and slowly developed into plaques and granuloma. Direct microscopic examination, fungal culture and pathological findings confirmed the diagnosis of facial mucormycosis due to Rhizomucor variabilis. In vitro susceptibility test indicated the pathogen was sensitive to ketoconazole but insensitive to fluconazole, itra-conazole or terbinafine. Then ketoconazole was administrated systemically and topically. The treatment was effective but was stopped about 2 months later because of some reasons. Seven months after the stopping the lesions aggravated and she was admitted to our institute again at the end of 2004, the second fungal culture found the same pathogen and the susceptibility test showed ketoconazole could not inhibit the fungus any more. Then am-photericin B was administrated for about 2 months with a total dose of 50 mg/kg. At the end of the second treatment the lesions improved remarkably. Three consecutive fungal and pathologic examinations could not find any clue of the fungus. Then the girl was discharged with oral administration of itraconazole 100 mg per day as the maintenance dosage. The patient is in follow-up until now. Our results show amphotericin B is effective for the treatment of mucormycosis.