title: Invasive mucormycosis in a patient with liver cirrhosis: case report and review of the literature.
abstract: BACKGROUND
  Cutaneous Mucormycosis is a rare opportunistic infection caused by Zygomycetes class of fungi that is often fatal, requiring aggressive local control as well as systemic therapy. Few cases of mucormycosis were described in patients with liver cirrhosis, mostly rhino-orbital. To our knowledge, only two cases of upper extremity involvement was reported in cirrhosis while a few cases were reported in the post-transplant setting. We report herein the third case of upper extremity mucor infection in the setting of liver cirrhosis.
  
  
  METHODS
  We described a rare case of forearm infection originating in a traumatic intravenous access portal in a 25 year-old woman with liver cirrhosis secondary to autoimmune hepatitis.
  
  
  CONCLUSIONS
  She developed acute on chronic liver failure during the last trimester of pregnancy, which was terminated. Painful, erythematous lesion was noted on her right forearm in the area of intravenous access, which later became necrotic. Extensive debridement was done and histopathological examination confirmed the diagnosis of mucormycosis. The patient started on Amphotericin B. Her condition continued to deteriorate and ended up with above elbow amputation followed by right shoulder disarticulation. She died two days later due to multi-organ failure. In conclusion, forearm mucromycosis in liver cirrhosis can be fatal.
authors.affiliation: Department of Liver Transplantation, King Faisal Specialist Hospital and RC, Riyadh, Saudi Arabia.
authors.forename: Hussien
authors.initials: H
authors.lastname: Elsiesy
authors.forename: Mohamed
authors.initials: M
authors.lastname: Saad
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Shorman
authors.forename: Samir
authors.initials: S
authors.lastname: Amr
authors.forename: Faisal
authors.initials: F
authors.lastname: Abaalkhail
authors.forename: Almoutaz
authors.initials: A
authors.lastname: Hashim
authors.forename: Waleed
authors.initials: W
authors.lastname: Al Hamoudi
authors.forename: Mohamed
authors.initials: M
authors.lastname: Al Sebayel
authors.forename: Khalid
authors.initials: K
authors.lastname: Selim
keywords: Amputation; Gangrene; Liver Cirrhosis; Mucormycosis