title: Survival of a patient with trauma-induced mucormycosis using an aggressive surgical and medical approach.
abstract: BACKGROUND
  Mucormycosis is a deadly angioinvasive fungal infection that is increasing in incidence. Gastrointestinal and abdominal involvement is rare, has higher mortality rates, and is frequently diagnosed late.
  
  
  METHODS
  We report a patient who sustained multiple gunshot wounds to the chest and abdomen and subsequently developed omental and hepatic mucormycosis. He underwent 14 abdominal washouts and several liver debridements, and he received combination therapy with amphotericin B and micafungin.
  
  
  RESULTS
  The patient survived the disease, with negative cultures and pathology at the last washout, and underwent skin grafting. He is clinically improved and remains on oral antifungals as an outpatient.
  
  
  CONCLUSIONS
  Mucormycosis should be considered in trauma patients with persistent signs of infection after lavage and antibiotics, especially when necrosis or atypical wound presentations are noted. Approaches such as ours using aggressive surgical management and intensive antifungal administration should be instituted once the diagnosis is suspected.
authors.affiliation: Section of Infectious Diseases, Department of Internal Medicine, Tulane University School of Medicine, New Orleans, Louisiana 70112, USA. nvansick@tulane.edu
authors.forename: Nicholas
authors.initials: N
authors.lastname: Van Sickels
authors.forename: Jordan
authors.initials: J
authors.lastname: Hoffman
authors.forename: Lance
authors.initials: L
authors.lastname: Stuke
authors.forename: Kelly
authors.initials: K
authors.lastname: Kempe
mesh_terms: D000007:Abdominal Injuries / Q000150:complications* / Q000382:microbiology; D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage / Q000627:therapeutic use; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D054714:Echinocandins / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D055666:Lipopeptides / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D000077551:Micafungin; D009091:Mucormycosis / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D012233:Rhizopus; D014948:Wounds, Gunshot / Q000150:complications* / Q000382:microbiology
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000666:Amphotericin B; D000077551:Micafungin