Limb-threatening necrotizing alternariosis salvaged by adjunctive hyperbaric oxygen therapy

Area of Science:

• Mycology
• Infectious Diseases
• Hyperbaric Medicine

Background:

• Necrotizing soft tissue infections caused by fungi, such as Alternaria, pose a significant threat, especially in immunocompromised patients.
• Standard antifungal treatments and surgical debridement may be insufficient to control invasive fungal infections.
• Hyperbaric oxygen therapy (HBO2) is an adjunctive treatment modality with potential antimicrobial and tissue-healing properties.

Observation:

• A 58-year-old immunocompromised patient with diabetes and Cushing's syndrome presented with limb-threatening necrotizing soft tissue infection of both legs caused by Alternaria.
• The infection progressed despite standard antifungal therapy and aggressive surgical debridement.
• Adjunctive hyperbaric oxygen therapy (HBO2) was initiated to manage the invasive fungal infection.

Findings:

• Hyperbaric oxygen therapy (HBO2) stabilized the invasive fungal infection, preventing further progression.
• The patient's wounds showed significant improvement and eventual healing following the adjunctive HBO2 treatment.
• This case demonstrates the successful limb salvage in necrotizing alternariosis through the use of HBO2.

Implications:

• Adjunctive hyperbaric oxygen therapy (HBO2) shows promise in treating severe, limb-threatening invasive fungal infections.
• HBO2 may potentiate host immune responses and enhance fibroblast proliferation, contributing to wound healing.
• Further research into HBO2 as an adjunctive therapy for invasive fungal infections is warranted.