Baranwal Harsh Vardhan, Katiyar Vivek K, Sharma Sumit, Mishra Shashi P, Bhartiya Satyanam K
Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND.
Division of Trauma Surgery, Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND.
Cureus. 2025 Aug 11;17(8):e89767. doi: 10.7759/cureus.89767. eCollection 2025 Aug.
Cutaneous mucormycosis is a rare but aggressive fungal infection, increasingly reported in trauma patients without traditional immunosuppressive risk factors. We report the case of a 22-year-old male who developed cutaneous mucormycosis following severe polytrauma from a motorbike-truck collision, presenting with a perineal degloving wound, bilateral testicular avulsion, urethral transection, and subtrochanteric femur fracture. He was resuscitated for hemorrhagic shock and underwent diversion colostomy, suprapubic catheterization, and serial debridement. Persistent necrosis despite antibiotics and negative-pressure wound therapy (NPWT) prompted fungal evaluation, confirming mucormycosis. Intravenous liposomal amphotericin B (5 mg/kg/day) with continued debridement controlled the infection, after which NPWT was reinitiated to optimize the wound bed. Definitive management included split-thickness skin grafting and femoral nailing, alongside testosterone replacement. Antifungal therapy transitioned to oral posaconazole after three weeks of amphotericin B. This case emphasizes early suspicion of mucormycosis in non-healing contaminated wounds, timely antifungal therapy, and staged multidisciplinary management, including cautious NPWT use, to achieve favorable outcomes.
皮肤毛霉病是一种罕见但侵袭性强的真菌感染，在没有传统免疫抑制危险因素的创伤患者中报告越来越多。我们报告一例22岁男性病例，该患者在摩托车与卡车碰撞导致严重多发伤后发生皮肤毛霉病，表现为会阴皮肤脱套伤、双侧睾丸撕脱、尿道横断和股骨转子下骨折。他因失血性休克接受了复苏，并接受了结肠造口术、耻骨上膀胱造瘘术和多次清创术。尽管使用了抗生素和负压伤口治疗（NPWT），但持续的坏死促使进行真菌评估，确诊为毛霉病。静脉注射脂质体两性霉素B（5mg/kg/天）并持续清创控制了感染，之后重新开始NPWT以优化伤口床。确定性治疗包括分层皮片移植和股骨钉固定，同时进行睾酮替代治疗。两性霉素B治疗三周后，抗真菌治疗转为口服泊沙康唑。该病例强调在不愈合的污染伤口中早期怀疑毛霉病、及时进行抗真菌治疗以及分阶段的多学科管理，包括谨慎使用NPWT，以取得良好的治疗效果。
