Mucormycosis Osteomyelitis of the Hand

Cutaneous Mucormycosis of the Upper Extremity

“…In our first described case, we also saw destruction of bony architecture of the distal ulna, which is not commonly observed. Kelpin et al 8 described this osteolytic process and paralleled it to the destruction that is commonly seen in mucormycosis of the maxillofacial skeleton 9 . Surgical debridement represents the cornerstone of treatment, as systemic antifungals are unable to penetrate the necrotic tissue resulting from this angioinvasive organism 8 …”

“…The second method uses 18s rDNA of Mucorales to obtain a tissue diagnosis within 48 hours 5 . In rhino-cerebro-orbital infections, Bhansali et al 10 found that delay in diagnosis and treatment with amphotericin alone increased mortality, adding support to the newer methods of rapid molecular diagnosis, which enable early aggressive surgical debridement 8 …”

“…Notably, the recognition of fungal hyphae within surgical specimens contaminated with necrotic debris and inflammatory changes can be a challenge and may require a dermatopathologist, which may not be universally feasible. Although false-negative frozen sections pose a problem for the operating surgeon, this is mitigated by the fact that species identification is not required, only the defining characteristics of broad, nonseptate hyphae with 90-degree branching to confirm the presence of mucormycosis presuming the species has been established prior 8 . Ultimately, intraoperative frozen section analysis and evaluation in conjunction with an experienced pathologist present a useful adjunct to clinical tissue evaluation and have the potential to improve the speed at which the disease is cleared in certain situations.…”

“…5 In rhino-cerebro-orbital infections, Bhansali et al 10 found that delay in diagnosis and treatment with amphotericin alone increased mortality, adding support to the newer methods of rapid molecular diagnosis, which enable early aggressive surgical debridement. 8 The end point of surgical debridement is continually debated in the literature, because there does not yet exist an undisputed method for confirmation of negative pathologic margins. 5 Debridement typically proceeds to active bleeding and healthy-appearing tissue, presumed to represent the absence of fungal disease; however, this cannot easily be confirmed microscopically at the time of debridement with the current methods.…”

“…Intraoperative frozen sections have been reported as many as 40 times during a single operation and, although this may be cumbersome, can reduce the risk of inadequate debridement and positive margins leading to amputation. 8 Notably, the recognition of fungal hyphae within surgical specimens contaminated with necrotic debris and inflammatory changes can be a challenge and may require a dermatopathologist, which may not be universally feasible. Although false-negative frozen sections pose a problem for the operating surgeon, this is mitigated by the fact that species identification is not required, only the defining characteristics of broad, nonseptate hyphae with 90-degree branching to confirm the presence of mucormycosis presuming the species has been established prior.…”