Necrotizing fasciitis caused by Mucor indicus in a pediatric bone marrow transplant recipient

Abstract

Necrotizing fasciitis is a life-threatening, rapidly progressing infection of fascia and subcutaneous cellular tissue typically caused by mixed aerobic and anaerobic bacteria. We present a case report of an immunocompromised 4-year-old female with necrotizing fasciitis from a rare fungal organism, Mucor indicus. The patient underwent multiple debridements and was treated for 10 months, first on liposomal amphotericin B (2 months) then posaconazole (8 months). Mucor indicus is a rarely described pathogen with only nine other cases described. Identification of this organism remains a challenge, and the need for further understanding of risk factors and organism susceptibility testing to help guide treatment is crucial.

Neuromucormycosis of Posterior Tibial Nerve: A Rare Presentation of Mucormycosis

“…There is a case report of mucor causing necrotizing fasciitis in pediatric bone marrow transplant recipient occurring as a result of vasculopathy. 7 In our case, we hypothesize that the tissue necrosis caused by vasculopathy may be a combined effect of both diabetes and invasive neuromucormycosis.…”

Disseminated Mucor indicus infection in a marmoset (Callithrix sp.)

“…Most cases involved gastrointestinal or hepatobiliary tracts, suggesting an oral route of infection 21,22 . Reports of M. indicus infections in the skin, vagina, aorta, and bone highlighted the importance of alternate portals of entry 23 …”

“…21,22 Reports of M. indicus infections in the skin, vagina, aorta, and bone highlighted the importance of alternate portals of entry. 23 In animals, M. indicus infection was only reported in an outbreak of rhinosinusitis in six horses from Saudi Arabia. 24 Herein, we describe the first case of gastric and hepatic mucormycosis in a marmoset due to M. indicus.…”

Polymicrobial Necrotizing Fasciitis in a Dog: The Involvement of Macrococcus caseolyticus, Proteus mirabilis, and Escherichia coli

“…Toxigenic strains of Corynebacterium ulcerans , isolates from dogs, have been associated with severe NF in human patients [ 18 ]. Mucor indicus , a zygomycete fungus, caused NF in a pediatric bone marrow transplant recipient [ 19 ]. Streptococcus agalactiae also caused an NF outbreak in a group of juvenile saltwater crocodiles, Crocodylus porosus [ 4 ].…”