Background: Mucormycoses are uncommon fungal infections with high morbidity and mortality rates. Apophysomyces spp are a known but rare pathogen. Successful treatment necessitates early diagnosis, surgical debridement, and systemic antifungal treatment. Case Presentation: A 7-year-old boy sustained a minor trauma to his leg and developed necrotizing acute soft tissue infection secondary to Apophysomyces varibilis. He required multiple surgical debridements and systemic antifungal therapy. He recovered well and had excellent results following skin grafting. Conclusion: Apophysomyces varibilis is an emerging pathogen in immunocompetent patients, most commonly acquired by traumatic innoculation.

Streptococcus gallolyticus pasteurianus (SGP) is normal flora in the human bowel but is seldom a pathogen in the setting of immunocompetency. A 14-month-old healthy child instrumented with a ventriculoperitoneal shunt developed acute otitis media and had a tap water enema administered for constipation. By report, fevers persisted and clinical signs of meningitis and peritonitis appeared. After 9 days of high-dose amoxicillin therapy, increased fever prompted a blood culture, which grew penicillin-susceptible SGP. Aseptic meningitis was discovered on lumbar puncture. The ventriculoperitoneal shunt was removed and was sterile for bacterial growth. Irritability and fever quickly resolved. High-dose amoxicillin treatment was ineffective in prevention of penicillin-sensitive SGP bacteremia and development of presumed SGP meningitis. Enemas in children with constipation may predispose to infectious complications from this gut flora organism from bacterial translocation or from rectal wall perforation.