Cutaneous Mucormycosis in a Chronic Immunocompromised State
Author(s):
Pooja Patel, St. Joseph's Hospital and Medical Center; Jonathan Taylor, St. Joseph's Hospital and Medical Center; Thomas Gillespie MD, St. Joseph's Hospital and Medical Center
Background: Mucormycosis is a fungal infection known to rapidly invade and kill human hosts, and oftentimes it is mistaken for the more common necrotizing soft tissue infection. Rhizopus, Absidia, and Mucor are the three fungal species most commonly seen to cause these infections; first, they produce a necrotic eschar commonly seen in the nose, and eventually go up through the cribriform plate to seed the brain. However, this classic pathway is not seen in all patients, especially those who have a suppressed immune response. Therefore, cutaneous forms of this infection can start anywhere and rapidly destroy tissues and vessels. The lack of immediate amphotericin therapy makes this such a fatal infection. Clinicians should keep Mucormycosis on the differential list of soft tissue infections, especially in patients who are experiencing some degree of immunosuppression.
Hypothesis: The severity of an infection may be undermined, as Mucor is not the most common of soft tissue infections seen clinically, leading to unchecked spread and early fatality.
Methods: We present a patient who developed cutaneous Mucormycosis, which was rapidly fatal due to his use of intravenous drugs and past medical history of malignant melanoma. We performed a literature review using New England Journal of Medicine, Journal of the American Medical Association, and PubMed to find and review other cases of cutaneous fungal infections, specifically Mucormycosis.
Results: Mucor is often missed on the differential of possible soft tissue infections, thus treatment is never empiric and more commonly delayed resulting in rapid progression and death.
Conclusions: Unfortunately, many of sources stated that diagnosis of Mucormycosis in the operating room is very difficult. However, if clinical suspicion is high and live specimens are examined under microscopy, it may be possible to detect and differentiate this infection early. Particularly, the use of fluorescence such as Blankophor and Calcofluor White could make Mucormycosis an easier diagnosis; however, this has yet to be implemented in healthcare facilities nationwide. Thus, with the technology currently used, the best way to treat any patient suspected of a potentially fatal cutaneous infection is with constant surveillance, initiation of a variety of intravenous antimicrobials, and generous surgical debridement in the operating room.