Cutaneous Mucormycosis in a Trauma Patient with a New Diagnosis of Diabetes Mellitus

Abstract

Background: Mucormycosis is an uncommon, but life-threatening fungal infection caused by the order Mucorales, family Mucoraceae. It is difficult to diagnose and manage, and it has a high fatality rate because of its rapid progression. Methods: We present a 34-year-old male trauma patient admitted following a motor vehicle accident. Results: While he had no medical history of diabetes mellitus, his admitting glycosylated hemoglobin (HbA1c) was 12.7%. On hospital day eight the patient developed an ecchymotic lesion on his left flank associated with surrounding erythema and edema. The edges of the lesion became necrotic and surrounding erythema expanded on hospital day ten. A white cotton-like appearance formed over the ecchymotic wound. An extensive surgical debridement was performed, extending to healthy bleeding tissue. A skin biopsy showed broad, large and non-separated fundal hyphae. On the same day, liposomal amphoteracin B at 5 mg/kg/day was started. The tissue culture was positive for Rhizopus species. The patient underwent multiple subsequent debridements and received a total course of 4 wks of liposomal amphoteracin B. Fifteen days from the initial surgical incision debridement, a split thickness skin grafting was performed. Conclusion: No mucormycosis relapse was noted 3 mo after initial fungal infection presentation.