P20 | Always keep in Mucor-mind fungal infections!

K. Borrelli, G. Ghigliazza, C. Folli, C. Casiraghi, G. Gazzano, P. Massironi, S. Serafini, M. Vaccari, C. Canetta | High Care Internal Medicine Unit Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy

Introduction: Mucormycosis is a rare fungal infection caused by ubiquitous fungi belonging to the order Mucorales. It’s most frequently observed in immunocompromised patients or immunocompetent following a significant trauma. We present the case of an immunocompetent woman who developed Mucormycosis after a minor skin trauma.
Clinical Decours: A 61-year-old woman, coping with depression and alcohol abuse, was admitted to the hospital due to septic shock caused by a soft tissue infection in her left leg, which developed after a minor skin trauma. Broad-spectrum antibiotic therapy was initiated and subsequently tailored based on specific bacteria identified in soft tissue and blood samples. Due to a worsening wound condition, surgical debridement, along with post-surgical VAC therapy, was performed. Mucor circinelloides was identified through histopathological analysis and cultures of surgical samples. To prevent the risk of a disseminated infection (mortality 70-100%) limb amputation was considered to achieve source control. However, due to the frailty of the patient, we opted for an attempt of conservative approach: bone samples were obtained and tested negative for fungal presence, finally addressing for a potentially avoidable amputation. The patient was successfully treated with surgical curettages, in combination with amphotericin B and isavuconazole.
Conclusions: Although rare and more often seen in predisposed patients, Mucormycosis should also be considered in the differential diagnosis of soft tissue infections arising from small skin traumas in immunocompetent patients.