Fusarium spp.-An Emerging Pathogen in Chronic Diabetic Ulcer: Case Report and Review of the Literature
Ana Luísa João1, André Lencastre1, Eduardo Dutra2
1Department of Dermatology and Venereology, Centro Hospitalar Universitário de Lisboa Central.
Abstract:
The genus Fusarium is ubiquitous in the environment and has been emerging as an opportunistic human pathogen. We report the case of a 65-year-old man with a history of neuroischemic, otherwise unamenable to revascularization, diabetic foot, who was admitted due to an infected deep foot ulcer. Despite conventional antibiotic and wound care treatment, no improvement was initially observed. A reappraisal of the diagnosis, with microbiological and histological analyses, documented infection of the foot ulcer with Fusarium oxysporum. Clinical improvement was noted under prolonged oral voriconazole therapy. The present case broadens the differential diagnosis of diabetic foot infection. Subcutaneous fusariosis should be considered in recalcitrant infected diabetic ulcers, as early diagnosis and management may help prevent amputation and life-threatening disease.
Insights
Fusarium oxysporum, a fungus, can infect diabetic foot ulcers unresponsive to antibiotics. Early diagnosis and voriconazole treatment are crucial for healing and preventing severe complications.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Podiatry
Background:
- Fusarium species are common environmental fungi.
- Opportunistic fungal infections are a growing concern, particularly in immunocompromised individuals.
- Diabetic foot infections pose significant challenges due to poor circulation and impaired healing.
Observation:
- A 65-year-old male with a diabetic foot ulcer, unresponsive to conventional treatment, was admitted.
- Microbiological and histological analyses revealed infection with Fusarium oxysporum.
- The patient had a history of neuroischemic complications rendering revascularization unfeasible.
Findings:
- Prolonged oral voriconazole therapy led to clinical improvement in the patient's infected diabetic foot ulcer.
- Fusarium oxysporum was identified as the causative agent of the recalcitrant ulcer.
- Standard antibiotic and wound care were initially ineffective against the fungal infection.
Implications:
- This case highlights Fusarium as a potential pathogen in recalcitrant diabetic foot infections.
- Subcutaneous fusariosis should be considered in the differential diagnosis of non-healing diabetic ulcers.
- Prompt diagnosis and antifungal treatment (e.g., voriconazole) may prevent limb amputation and systemic spread.
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