Burn Wound Mucormycosis: A Case Study on Poor Wound Healing.
Mucormycosis is a rare, rapidly progressive and often fatal fungal infection. The rarity of the condition lends itself to unfamiliarity, delayed treatment, and poor outcomes. Diagnosis of fungal infections early enough to enable appropriate treatment occurs in less than half of affected patients. A 56-year-old male with a history of diabetes mellitus II, hepatitis C, and intravenous drug abuse was involved in a rollover motor vehicle accident. He sustained circumferential partial and full-thickness burns to his lower extremities with 20% BSA burns. He ultimately required a below-knee amputation of his right lower extremity due to poor wound healing and nonviability of the soft tissue and foot. Debridement found muscle fibers that were necrotic and purulent. Pathology revealed Mucor species with extensive vascular invasion. This case and discussion highlights the importance of maintaining vigilance for mycotic infections and acting appropriately when there are concerning signs and symptoms of serious wound complications. Caretakers of severe trauma patients should have a high level of suspicion for complications and be cognizant of the American Burn Association's guidelines for systemic inflammatory response syndrome and sepsis. Progressive necrosis outside the confines of the original burn wound should raise concern for impaired wound healing, an immunocompromised state or an underlying infection.
From the *Department of Internal Medicine and Pediatrics, and †Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York.
Bryan
B
Stanistreet
Derek
D
Bell
D000063:Accidents, Traffic; D000671:Amputation, Surgical / Q000009:adverse effects* / Q000379:methods; D000935:Antifungal Agents / Q000627:therapeutic use; D001707:Biopsy, Needle; D002056:Burns / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D018450:Disease Progression; D017809:Fatal Outcome; D015600:Glasgow Coma Scale; D006801:Humans; D007150:Immunohistochemistry; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D009091:Mucormycosis / Q000188:drug therapy / Q000503:physiopathology*; D014945:Wound Healing; D014946:Wound Infection / Q000175:diagnosis* / Q000628:therapy
D000935:Antifungal Agents