CHSU Discovery

Mucormycosis is an Angioinvasive fungal infection caused by the fungi order Mucorales. It is a rare disease affecting 1.7 people per every 1,000,000 in the general population with an overall all-cause of mortality rate of 54%. We present the case of a 66 yo m w/ Hx of T2DM, HTN, Esophageal CA s/p Partial Esophagectomy and Partial Gastrectomy who presented to the ED after sustaining a laceration on his scalp, which developed initially a scab and subsequently developed redness, pain, and swelling spreading to his forehead and left eye. Exam notable for necrotic area in the middle of the scalp with surrounding erythema spreading to the left forehead. Labs revealed lactic acidosis, leukocytosis, hyperglycemia. CT Head showed possible frontal area hematoma. Wound culture showed Cuti bacterium Propionibacterium acnes. Scalp Tissue pathology revealed Necrotizing Fasciitis with vascular and neural invasion by Mucormycosis. Pt started on empiric IV Vanc, Zosyn, and Diflucan. General Surgery performed Multiple debridements. Once pathology showed Mucormycosis, Pt was started on IV Amphotericin B and transferred to Tertiary Center for L FESS and Left Orbital Decompression, left supraorbital abscess washout, and further scalp debridement. Pt was transferred back to Tulare and continued on Amphotericin IV, electrolytes aggressively repleted, then discharged to SNF on Posaconazole. Mucormycosis is very uncommon. Diagnosis is dependent on pathology report and imaging is used to see the extent of disease. Surgical intervention and high-dose liposomal Amphotericin B are strongly recommended. Early identification of the disease and prompt medical and surgical intervention is required to prevent high mortality associated with mucormycosis.