Cutaneous mucormycosis of the lower extremity leading amputation in two diabetic patients

Fracture-Related Infection of the Lower Limb Caused by Mucor velutinosus: Amputation or Salvation?

Fracture-related infections caused by mucormycosis are rare and potentially fatal. Evidence-based experience with its treatment is limited, and surgical management ranges from limb salvage to amputation, with indications not always clear. A 56-year-old woman was admitted after an aircraft accident, sustaining major trauma injuries, including a Gustilo-Anderson type III open ankle joint fracture. Initial damage control surgery with external fixation ensued, followed by secondary, definitive internal fixation with plate and screws. The patient developed a fracture-related infection in the ankle caused by Mucor velutinosus. Despite its invasive growth and tenacity, surgical debridement combined with systemic and local antifungal therapy led to remission in this immunocompetent patient. The ankle arthrodesis achieved bone union with a hexapod fixator 10 months post-trauma. In the treatment of opportunistic invasive mucormycosis, a multidisciplinary approach is necessary, especially in patients suffering major trauma injuries. Through apt diagnosis and thorough treatment by experienced surgeons, infectiologists, and pathologists, successful limb salvage may be attained in patients with an otherwise intact immune system, and amputation can be prevented.

Proven Cutaneous Mucormycosis in a COVID-19 Patient: A Case Report and Literature Review

There has been a rise in COVID-19-associated mucormycosis (CAM) cases, particularly in low-income countries. We describe a case of primary cutaneous mucormycosis after recovering from COVID-19 in a kidney transplant recipient who had a known case of diabetes mellitus. The patient developed cutaneous ulcers due to Rhizopus oryzae in the right hand. She did not recall any trauma or injury at the affected site. Based on the appearance of the wound we suspected that healthcare-associated mucormycosis could be the causative agent. Due to the initial misdiagnosis as a bacterial infection, the appropriate treatment was delayed, and the lesions progressed rapidly to necrotic ulcers with jagged margins that deteriorated during hospitalization. She underwent consecutive surgical interventions and received broad-spectrum antifungal therapy. Finally, the patient deceased after 32 days of hospital stay. We reviewed the previous case reports of cutaneous mucormycosis occurring in COVID-19 patients and described patient characteristics, predisposing factors, location of ulcers, clinical presentation, management, and outcome. This report and existing published literature indicate a poor outcome for cutaneous mucormycosis in COVID-19 patients and the importance of early diagnosis, aggressive multidisciplinary management, and regular follow-up as a life-saving measure, especially in immunocompromised patients.