A Common Fungus, an Unusual (and Deadly) Infection

Abstract

h i r r n h PRESENTATION We describe a case in which an immunocompetent patient with several comorbid conditions ultimately died of an uncommon infection. A 64-year-old woman with a history of poorly controlled diabetes mellitus type II and chronic alcohol abuse was transferred to our facility for a hepatology evaluation for severe hepatic encephalopathy and fulminant liver failure. Shortly after arrival, she was intubated for airway protection, and a nasogastric tube was placed for gastric decompression. Laboratory studies and a liver biopsy performed shortly after her arrival confirmed a diagnosis of hemochromatosis, with iron deposition noted on the specimen (Figure 1). Within 24 hours of the placement of the nasogastric tube, the patient developed a small area of necrosis at the right nare. Despite immediate removal of the tube, the necrotic area rapidly worsened (Figure 2).