Necrotizing fasciitis caused by cutaneous mucormycosis: case report

Background: Mucormycoses 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 primary infection is localized in the skin with a great number of cases presenting in healthy patients who have suffered severe trauma or burns. Zygomycetes tend to invade an artery, which leads to thrombosis and generates wide necrotic areas, favoring the progress of the infection and invasion of deep tissues. Up to 24% of cases of primary cutaneous mucormycosis can be complicated with necrotizing fasciitis. Clinical Case: We present the case of a 52-year-old male with a clinical diagnosis of necrotizing fasciitis. The patient received broad-spectrum antibiotics and was submitted to extensive debridement of the wound bed. Intraoperative biopsy revealed the presence of zygomycetes in the tissues, and diagnosis of primary cutaneous zygomycosis was made. Antifungal treatment with amphotericin B was initiated and 2 weeks later autologous skin grafts were applied over the wounds. Conclusion: A high index of suspicion is needed to diagnose cutaneous zygomycosis; therefore, it should always be considered among the differential diagnoses of necrotic wounds unresponsive to standard treatment. Rapid evolution of the disease reinforces the importance of early biopsy of the wound bed and aggressive treatment.