Allograft of Primary Cutaneous Mucormycosis in a Preterm Neonate: A Case Report

Introduction. Primary cutaneous mucormycosis (PCM) is a fungal infection of the skin that can affect compromised hosts. Skin lesions evolve from an indurated area to a necrotic ulcer. Preterm neonates are at increased risk due to poorly developed skin, immature immune function, and invasive devices. Antifungals and debridement with grafting have been reported as primary treatments. Case Report. The authors report allografting in addition to systemic antifungals as an option for critically ill preterm neonates to decrease blood loss and risk of donor site infection. A female triplet was born to a 35-year-old G1P0211 mother at 23(4+) weeks gestation; the triplet developed PCM (Rhizopus genus) and was treated with systemic liposomal amphotericin B in addition to debridement and allografting. Surgery was delayed initially, given concerns over the depth of invasion into the chest. As the wound began to contract and separate over the next few weeks, the decision was made to excise the lesion and reconstruct the chest wall with an allograft. The graft had good take and remained in place for 11 weeks until the patient succumbed to a third recurrence of bacterial sepsis. Conclusions. While PCM can be fatal for many preterm infants, debridement with allografting may serve as a valuable treatment option with fewer associated complications for neonates as they are stabilizing clinically.