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Post-traumatic cutaneous mucormycosis in diabetes mellitus. Short-term antifungal therapy
K Ryan-Poirier1, R M Eiseman, J H Beaty
1Department of Pediatrics, University of Tennessee, Memphis.
Abstract:
Mucormycosis is infrequently encountered in the pediatric population in any of its forms (nasopharyngeal, disseminated, pulmonary, or cutaneous) and generally is associated with the immunocompromised host. We present an adolescent with poorly controlled diabetes mellitus who developed a progressive skin lesion 3 weeks after a motor vehicle accident. Rhizopus species was isolated from the lesion, and the biopsy revealed a fungal vasculopathy. Control of her diabetes, aggressive surgical intervention and a 10-day course of antifungal therapy (amphotericin B) resulted in a favorable outcome. This article illustrates the importance of considering cutaneous fungal infections, especially those in the class zygomycetes, in the diabetic patient with unusual, severe or persistent skin lesions. Early recognition is essential in order to avoid morbidity and mortality from this unusual opportunistic infection.
Insights
A rare fungal infection, mucormycosis, affected an adolescent with diabetes. Prompt treatment including antifungal therapy and surgery led to a positive outcome, highlighting early detection importance.
Area of Science:
- Mycology
- Pediatric Infectious Diseases
- Dermatology
Background:
- Mucormycosis is a rare fungal infection, particularly in children, often linked to compromised immune systems.
- Cutaneous mucormycosis, a skin manifestation, is less common but can be severe, especially in immunocompromised individuals.
- Diabetes mellitus is a known risk factor for invasive fungal infections.
Observation:
- An adolescent with poorly controlled diabetes mellitus presented with a progressive skin lesion following a motor vehicle accident.
- The lesion was identified as a fungal infection caused by Rhizopus species.
- Biopsy confirmed fungal vasculopathy, indicating fungal invasion of blood vessels.
Findings:
- The patient received a 10-day course of amphotericin B, an antifungal medication.
- Aggressive surgical intervention was performed to remove the infected tissue.
- Effective management of the patient's diabetes mellitus was crucial for recovery.
Implications:
- This case underscores the importance of considering mucormycosis, specifically zygomycetes, in diabetic patients with unusual or persistent skin lesions.
- Early recognition and prompt, multidisciplinary treatment are essential to prevent severe morbidity and mortality associated with cutaneous fungal infections.
- The case highlights the need for vigilance in diagnosing opportunistic infections in pediatric patients with underlying conditions like diabetes.