Case Report A Proven Case of Cutaneous Rhizopus Infection Presenting with Severe Limb Pain Very Soon after Induction Treatment in a Patient with Acute Lymphoblastic Leukemia Mehmet Sezgin Pepeler, 1 Kadir Acar, 1 Özlem Güzel Tunçcan, 2 Ömer UluoLlu, 3 AyGe KalkancJ, 4 Hakan Atalar, 5 Koray KJlJç, 6 and Gülsan Türköz Sucak 1 1 Department of Hematology, Gazi University Faculty of Medicine, Ankara, Turkey 2 Department of Infectious Disease, Gazi University Faculty of Medicine, Ankara, Turkey 3 Department of Pathology, Gazi University Faculty of Medicine, Ankara, Turkey 4 Department of Microbiology, Gazi University Faculty of Medicine, Ankara, Turkey 5 Department of Orthopedics, Gazi University Faculty of Medicine, Ankara, Turkey 6 Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey Correspondence should be addressed to Mehmet Sezgin Pepeler; drsezgin44@gmail.com Received 25 October 2014; Revised 11 January 2015; Accepted 12 January 2015 Academic Editor: Kazunori Nakase Copyright © 2015 Mehmet Sezgin Pepeler et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective and Importance. Invasive mucormycosis may complicate the course of patients with hematologic malignancies and has a very high mortality rate. Early diagnosis and aggressive approach combined with surgical and medical treatment have paramount importance for cure. Clinical Presentation. We report here a case of a patient with acute lymphoblastic leukemia presenting with a subcutaneous mass lesion which was sampled by an ultrasound guided needle biopsy. Te pathology showed microorganisms with aseptate hyphae with wide, irregular walls and more or less branching with highly vertical angles which suggested a mold infection. Te specimen was also cultured where Rhizopus spp. grew. Conclusion. Posaconazole 200 mg QID was commenced. She recovered from neutropenia and pain on day 20 of treatment. Afer 4 courses of hyper-CVAD chemotherapy, the remaining sof tissue mass was removed surgically and she underwent allogeneic HSCT from a full matched sibling donor under secondary prophylaxis. 1. Introduction Invasive fungal infections are major causes of morbidity and mortality in immunosuppressed patients. Invasive mucormy- cosis (IMM) is the third most frequent invasive fungal infection afer aspergillosis and candidiasis in patients with acute leukemia [1]. Te incidence has risen signifcantly in the past decades with the rapidly growing number of highly immunosuppressive treatment modalities such as stem cell and solid organ transplantation and the use of broad spec- trum antimicrobial and antifungal agents. Te established risk factors are immunosuppression, diabetes mellitus, iron overload, deferoxamine treatment, and graf versus host disease [1]. Here, we present a patient with none of the above risk factors; a young agricultural worker is on the eighth day of leukemia induction chemotherapy. She was neutropenic, though not for a long time, and was not on broad spectrum antibiotics and she was not diabetic. We believe that her occupation was the underlying cause and the port of entry for the pathogen was a possibly an unnoticed point of skin dehiscence which occurred before the diagnosis of leukemia. 2. Case Report A 27-year-old female, who worked as an agricultural laborer, was referred to our hospital with complaints of fatigue, malaise, anorexia, and epistaxis. Her physical examination revealed pallor and eczematous plaques in her chest and the proximal part of her right arm. She also had splenomegaly of 6 cm below the costal margin. Laboratory investigation Hindawi Publishing Corporation Case Reports in Hematology Volume 2015, Article ID 285360, 4 pages http://dx.doi.org/10.1155/2015/285360