Froes Chadley, Gellatly Matthew, Watson Brian
Department of Internal Medicine, Grand Strand Medical Center, Myrtle Beach, SC 29572, USA.
Department of Pathology, Grand Strand Medical Center, Myrtle Beach, SC 29572, USA.
IDCases. 2022 Jul 27;29:e01589. doi: 10.1016/j.idcr.2022.e01589. eCollection 2022.
Mucormycosis is a rare opportunistic fungal infection with a high degree of morbidity and mortality. It classically presents with rapidly progressing, necrotic rhinocerebral mucocutaneous lesions in the setting of an immunocompromised host, especially with concomitant uncontrolled diabetes. We report the case of a 67-year-old man with well-controlled non-insulin dependent diabetes and brief steroid exposure who presented in sepsis with a tender posterior shoulder skin lesion. The initial lesion enlarged and progressed over several days, developing central areas of ecchymosis and bullae, with several other large lesions appearing at various distant sites. He also experienced an array of systemic symptoms, including fever, malaise, weakness, and acute encephalopathy. A diagnosis of mucor was made by histopathological examination of the initial skin lesion. Despite initiation of amphotericin B and aggressive surgical debridement including transfer to specialist tertiary burn center, the patient passed away less than a week after definitive diagnosis. This is a unique case of disseminated mucormycosis given his lack of chronic immunosuppression or uncontrolled diabetes, and with no risk factors for inoculation except for pacemaker placement 2 months prior to admission. The case highlights the importance of considering mucormycosis in the early differential diagnosis of rapidly progressing skin lesions, as rapid detection and treatment is critical to mitigate the deadly effects of this fast-moving fatal fungus. Moreover, the case serves as a testament to the unpredictable progression of disseminated disease, while also demonstrating an unusual potential mode of introduction and a rare but fatal consequence of prescribing corticosteroids in an infected host.
毛霉病是一种罕见的机会性真菌感染，发病率和死亡率很高。典型表现为在免疫功能低下的宿主中，尤其是伴有未控制的糖尿病时，迅速进展的坏死性鼻脑黏膜皮肤病变。我们报告了一例67岁男性病例，他患有病情控制良好的非胰岛素依赖型糖尿病，短期使用过类固醇，因后肩部皮肤压痛性病变出现败血症。最初的病变在数天内扩大并进展，出现瘀斑和大疱的中央区域，同时在其他多个远处部位出现了几个大的病变。他还出现了一系列全身症状，包括发热、不适、虚弱和急性脑病。通过对最初皮肤病变进行组织病理学检查确诊为毛霉感染。尽管开始使用两性霉素B并进行了积极的手术清创，包括转至专科三级烧伤中心，但患者在确诊后不到一周就去世了。鉴于他没有慢性免疫抑制或未控制的糖尿病，除了入院前2个月植入起搏器外没有接种的危险因素，这是一例独特的播散性毛霉病病例。该病例强调了在快速进展的皮肤病变早期鉴别诊断中考虑毛霉病的重要性，因为快速检测和治疗对于减轻这种快速传播的致命真菌的致命影响至关重要。此外，该病例证明了播散性疾病进展的不可预测性，同时也展示了一种不寻常的潜在感染途径以及在感染宿主中使用皮质类固醇罕见但致命的后果。
