Subcutaneous Phycomycosis: a Review of 31 Cases Seen in Uganda.

Case 5 received 10 further courses of melphalan, and the disease remained well controlled until the last 10 weeks of life, when the growth extended extremely rapidly. He received one further course of radiotherapy for local pain. Case 9 received eight further courses of melphalan, and the disease was well controlled except for local pain from pathological fractures of ribs which was relieved by irradiation. At post-mortem examination a gastric carcinoma, suspected in the last three months of life, was found. Cases 8, 9, 12, 14, and 16 did not benefit from melphalan therapy. Seven further patients have been treated, four of whom obtained relief of pain for periods up to 16 months; one did not respond to melphalan or to cyclo-phosphamide, and required repeated courses of local irradiation ; two patients in renal failure failed to respond, and in one case profound and prolonged neutropenia and thrombocyto-penia followed each of two courses of melphalan lasting 14 and 7 days at a daily dose of 5 mg. Subcutaneous phycomycosis is an infection of the subcutaneous fat by a fungus of the family Entomophthoraceae, usually of the genus Basidiobolus, that results clinically in a slowly increasing painless area of subcutaneous induration which is small initially but can sometimes reach very large dimensions. The clinical syndrome of subcutaneous phycomycosis was first reported from Indonesia by Lie Kian Joe et al. (1956). Subsequently eight further cases were reported from Indonesia The description of phycomycosis given here is based on a series of 31 patients seen in Uganda, 21 of whom were examined personally by at least one of us. The others were traced through a retrospective survey of histological sections and hospital case-notes. This series includes the two cases previously reported from Uganda. The clinical features of this lesion, which have been summarized by Burkitt et al. (1963), are characteristic. The condition had in fact been recognized as a clinical entity at Mulago Hospital for many years before the responsible organism was identified on histological section or growth in culture. The real nature of the lesion was not recognized until 1961, when Beaver identified the responsible organism in tissue removed from a child in Mulago Hospital (Jelliffe et al., 1961). One of us (A. M. M. W.) at the same time recognized another case in Kampala as a mycosis and subsequently cultured the organism. As has been pointed out, the earliest reports came …