"Adjunctive topical amphotericin B in post-transplant surgical-site mucormycosis in an immunocompromised diabetic...

Cutaneous mucormycosis is a rapidly progressive and often fatal fungal infection predominantly affecting immunocompromised hosts, with post-transplant patients being particularly vulnerable due to immunosuppressive regimens and metabolic derangements. Despite its high mortality, especially in the context of surgical-site involvement, optimal therapeutic strategies remain underexplored. We present a rare case of surgical-site mucormycosis in a renal transplant recipient with poorly controlled diabetes, successfully managed using adjunctive topical antifungal therapy, highlighting a potential treatment strategy in immunosuppressed populations.

A middle-aged male with chronic kidney disease, recent renal transplantation, and persistent hyperglycemia developed a non-healing surgical-site wound. Early clinical suspicion led to a bedside potassium hydroxide mount and expedited fungal cultures, which revealed mucormycosis. The patient was promptly initiated on systemic liposomal amphotericin B and, uniquely, adjunctive topical amphotericin B applied directly to the wound bed. Despite the challenges of ongoing immunosuppression, renal dysfunction, and glycemic instability, the patient demonstrated significant local and systemic improvement without the need for disfiguring surgical debridement.

This case underscores the diagnostic value of bedside fungal microscopy in resource-limited and time-sensitive settings, where conventional culture and histopathology may be delayed. The clinical decision to incorporate topical amphotericin B, an underutilized yet mechanistically sound adjunct, was based on the rationale of high local fungal burden, systemic drug toxicity concerns, and limited evidence in immunosuppressed surgical cohorts. This approach not only curtailed disease progression but also preserved graft integrity and patient quality of life. This case highlights the under-recognition of mucormycosis in post-transplant surgical wounds and the absence of standardized topical antifungal protocols, representing a critical gap in transplant infectious disease management.

This case report highlights that early bedside diagnosis, combined with individualized adjunctive topical amphotericin B, may help control post-transplant surgical-site mucormycosis, reduce the need for morbid surgical interventions, and warrants further evaluation for incorporation into future treatment guidelines for high-risk immunocompromised patients.