[Necrotizing fasciitis caused by cutaneous mucormycosis. A case report].
BACKGROUND
Mucormycosis are opportunistic infections with high morbidity and mortality caused by fungi of the class Zygomycetes, they mainly affect diabetic and immunocompromised patients. In up to 20% of all cases the main infection is localized in the skin, with a great number of them presenting in healthy patients that have suffered from severe trauma or burns. Zygomycetes tend to invade arteries, which leads to thrombosis and generates wide necrotic areas; this favors the progress of the infection and invasion of deep tissues. Up to 24% of primary cutaneous mucormycosis can be complicated with necrotizing fasciitis.


METHODS
We present the case of a 52 year-old male that received the clinical diagnosis of necrotizing fasciitis. The patient received wide spectrum antibiotics and was submitted to extensive debridement of the wound bed; transoperative biopsy revealed the presence of zygomycetes in the tissues and the diagnosis of primary cutaneous zygomycosis was made. Antifungal treatment with amphotericin B was initiated and two weeks later autologous skin grafts were applied over the wounds.


CONCLUSIONS
A high index of suspicion is needed to diagnose cutaneous zygomycosis, therefore it should always be considered amongst the differentials of necrotic wounds that do not respond to standard treatment. The rapid evolution of the disease remarks the importance of biopsying the wound bed early and treating aggressively.
Escuela de Medicina Universidad Panamericana, D.F. México. 0046190@up.edu.mx
José Eduardo
JE
Telich-Tarriba
Andric Christopher
AC
Pérez-Ortíz
José
J
Telich-Vidal
D000063:Accidents, Traffic; D000666:Amphotericin B / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001706:Biopsy; D003131:Combined Modality Therapy; D003646:Debridement; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D019115:Fasciitis, Necrotizing / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D006801:Humans; D006973:Hypertension / Q000150:complications; D007869:Leg Injuries / Q000150:complications; D007871:Leg Ulcer / Q000209:etiology / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D009091:Mucormycosis / Q000150:complications* / Q000382:microbiology; D012307:Risk Factors; D016038:Skin Transplantation; D012907:Smoking; D014946:Wound Infection / Q000209:etiology / Q000382:microbiology
D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D000666:Amphotericin B