SHM Converge Scientific Abstract ePoster Gallery-There's a Fungus Among Us: A Case of Mucormycosis in the Setting of Calciphylaxis

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This case describes a rare and severe episode of cutaneous mucormycosis occurring in a calciphylaxis wound. A 41-year-old man with type 1 diabetes, end-stage renal disease on hemodialysis, calciphylaxis, and anemia presented with worsening pain, malodor, and bleeding from a left thigh lesion. Exam showed a large unroofed blister with surrounding necrotic-appearing dark skin, and he was febrile, tachycardic, and mildly tachypneic. CT of the thigh demonstrated soft tissue gas concerning for necrotizing fasciitis.<br /><br />He underwent emergent surgical debridement and wound vacuum placement, and broad-spectrum antibiotics were started. Initial bacterial cultures grew Staphylococcus epidermidis and Clostridium perfringens, while fungal and mycobacterial cultures were initially negative. Several weeks later, histopathology from an enlarging adjacent lesion identified Rhizopus species, confirming mucormycosis despite earlier negative cultures. He required additional debridements and was treated with liposomal amphotericin B, with posaconazole added later.<br /><br />The patient subsequently developed right eye swelling, and imaging revealed a left upper lobe cavitary lung lesion. Bronchoscopy and fungal studies remained negative, but his course continued to worsen with an Enterobacter empyema and progressive decline. He ultimately transitioned to comfort care and died, with suspected progression from localized cutaneous disease to systemic infection.<br /><br />This report highlights that mucormycosis is a rare, high-mortality fungal infection most often caused by Rhizopus, Mucor, Lichtheimia, and Rhizomucor species. Major risk factors include diabetes, immunosuppression, trauma, and other states of impaired host defense. In this patient, diabetes plus skin breakdown from calciphylaxis likely created a high-risk portal of entry. Diagnosis is often difficult because cultures may be negative, making histopathology essential. Optimal management requires prompt surgical debridement plus antifungal therapy, typically liposomal amphotericin B and posaconazole.

Asset Subtitle

Mary-Nel Saarloos

Meta Tag

Author List Jennifer M. Chang-Wolf, Mary-Nel Saarloos

Category Clinical Vignettes

Concept Cutaneous Mucormycosis

Concept Mucormycosis

Concept Surgical Debridement

Concept Liposomal Amphotericin B

Concept Calciphylaxis

Distinguished Non-Finalist

Presenter Organization Duke University Hospital

Presenting Author Mary-Nel Saarloos

Track Adult

Keywords

cutaneous mucormycosis

calciphylaxis

Rhizopus

type 1 diabetes

end-stage renal disease

hemodialysis

necrotizing fasciitis

liposomal amphotericin B

posaconazole

surgical debridement

Cutaneous Mucormycosis

Mucormycosis

Surgical Debridement

Liposomal Amphotericin B

Calciphylaxis