Left hand necrosis as the initial presentation of disseminated mucormycosis: A case report and literature review

Abstract

Cutaneous mucormycosis typically occurs as a primary infection following traumatic inoculation or as a secondary disseminated disease in immunocompromised patients with hematologic malignancy or organ transplantation. We describe an unusual case of a poorly controlled type 1 diabetic patient presenting with wet gangrene of the hand due to angioinvasive dissemination from a primary pulmonary infection, with additional suspected foci of cardiac and central nervous system involvement. Despite combined medical and surgical treatment, the patient ultimately died due to complications of her infection. This case and the associated literature review of secondary cutaneous mucormycosis highlight that invasive fungal infections can present peripherally, and identifying the primary source is important in order to promptly pursue aggressive combined medical and surgical treatment for this highly fatal disease.

Mucormycosis in the Hand

“…In uncontrolled diabetes with diabetic ketoacidosis, uninhibited fungal invasion is trigged by impaired neutrophil chemotaxis, phagocytosis, decreased pH, and increased unbound iron. Hematogenous spread from the primary lung source is also reported in cutaneous mucormycosis 9,10 . Uncontrolled diabetes mellitus with ketoacidosis and secondary dissemination from the lung or spore inhalation from the farm fields may be one of the reasons for the infection in our case.…”