Primary mucormycosis of abdominal wall: A rare fungal infection in a immunocompetent patient

Abstract

Mucormycosis of the anterior abdominal wall is an uncommon disease and it is very rare to find this disease in immunocompetent, non-diabetic patients which usually affects patients with trauma, with contaminated wounds, patients with underlying malignancies or patients with immunocompromised state, e.g., diabetics. We herein report a case of primary cutaneous mucormycosis in an immunocompetent and non-diabetic patient. Our patient was a 48-year-old female, executive by profession. She was diagnosed to have cutaneous mucormycosis of the anterior abdominal wall, and was managed with multiple debridements of the wound and intravenous amphotericin B therapy. She was administered a total of 1500 mg of liposomal amphotericin B and when fully healed, split skin grafting was done. We would like to emphasize the importance of high index of suspicion and early start of therapy in a condition with high rate of mortality.

Posttraumatic Mucormycosis

“…Most common traumatisms were traffic accident (37%), domestic accidents (15.1%), natural disaster (14%), farm working accident (12.6%), and animal or insect bite (8.4%) (including 2 scorpion stings, 1 spider bite, 1 magpie peck, and 1 dog scratch). 2 , 3 , 15 , 18 , 23 , 29 , 34 , 35 , 37 , 39 Natural disasters were Joplin tornado (13 cases), 22 collapse of building (1 case), 2 and Asian tsunami (2 cases) 1 , 33 (Figure 6 ). Half of wounds were described as extensive soft-tissue damage, 8 (6.5%) deep burns that occurred in a soil contamination context, 25 (20.5%) as penetrating wound and 31 (25.4%) as superficial lesions.…”

“…Half of wounds were described as extensive soft-tissue damage, 8 (6.5%) deep burns that occurred in a soil contamination context, 25 (20.5%) as penetrating wound and 31 (25.4%) as superficial lesions. The latter 2 included a great proportion of insect or animal bites, 2 , 3 , 15 , 18 , 23 , 29 , 34 , 35 , 37 , 39 penetrating injury with plant material (for example, a thorn), but also surprising traumas as crab trap 16 or wooden matchstick injuries. 13 More than one-third of the wounds were observed on the lower limbs (n = 47), followed by the cephalic extremity (n = 28) (see Table 2 ).…”

Mucormicosis periostomal posoperatoria, a propósito de un caso

“…Si bien existen publicaciones de su ocurrencia en pacientes inmunocompetentes 6,8 , tal como en el caso expuesto, lo habitual es que el paciente tenga antecedente de inmunosupresión, ya sea por enfermedad, uso prolongado de corticoides 14 o inmunosupresión inducida en receptores de trasplantes de órganos 4,5 , siendo la diabetes mellitus y las neoplasias hematológicas las condiciones asociadas más frecuentes (40% y 33% respectivamente) 2 .…”

“…Las manifestaciones clínicas más frecuentes son la rinocerebral, pulmonar, cutánea, gastrointestinal y diseminado. Otras infrecuentes son endocarditis, osteomielitis y renal 1,2 En cuanto a la mucormicosis cutánea, por lo general existe el antecedente de trauma o cirugía [2][3][4][5] que permite una puerta de entrada, aunque también se han descrito casos secundarios a mordeduras de arañas 6 , sitios de inyección de medicamentos 7 e incluso espontáneo 8 .…”

Successful surgical management of primary abdominal wall mucormycosis in an immunocompetent patient

“…Rarely it can occur in immunocompetent patients without any comorbidities. 2 We report an extremely rare case of primary mucormycosis of anterior abdominal wall inan immunocompetent patient.…”