Fracture-related infection of the lower limb caused by Mucor velutinosus: amputation or salvation?

Abstract

Purpose: Fracture-related infections caused by mucormycosis are rare and potentially fatal. Evidence-based experience with its treatment is limited and surgical management ranges from limb salvage to amputation, with indications not always clear. Case presentation: A 56-year-old woman was admitted after an aircraft accident, sustaining major trauma injuries, including a Gustilo-Anderson type III open ankle joint fracture. Following initial damage control surgery with external fixation, the patient developed a fracture-related infection in the ankle caused by Mucor velutinosus. Despite its invasive growth and tenacity, surgical debridement combined with systemic and local antifungal therapy led to remission in this immunocompetent patient. The ankle arthrodesis achieved bone union with a hexapod fixator 10 months post trauma. Conclusion: In the treatment of invasive mucormycosis, a multidisciplinary approach is necessary. Through apt diagnosis and thorough treatment by experienced surgeons, infectiologists and pathologists successful limb salvage may be attained in patients with an intact immune system and amputation can be prevented.