Introduction: Mucormycosis is a rare but dangerous invasive infection caused by an opportunistic environmental mold. Mostly seen in immunocompromised hosts, even with early treatment, it can be rapidly fatal. We herein report an unusual presentation of mucormycosis in a patient who initially presented with polytrauma from a motor vehicle accident (MVA).

Case Presentation: A 43-year-old female with type 1 diabetes mellitus presented with polytrauma following an MVA. Injuries included a fracture of her right humerus requiring surgery. She was discharged only to present a week later with concern for infection at the surgical site. Antibiotics were initiated, and she underwent debridement and irrigation (D&I), which revealed dark, devitalized tissue involving the hardware. Cultures grew Rhizopus, and she was treated with isavuconazole. She underwent multiple D&Is with each revealing copious necrotic tissue. She ultimately required shoulder disarticulation. She was discharged home with continued medical treatment. Days later, she was re-admitted with wound dehiscence and new formation of a black eschar. CT suggested ongoing infection at the stump bed. Despite aggressive antimicrobial treatment, she worsened clinically, and the medical team made clear to her and her family that her infection was immediately life-limiting.

Final Diagnosis: The patient was diagnosed with disseminated mucormycosis, initially manifesting as a cutaneous infection at her surgical site.

Management/Outcome: Despite the surgical team’s and medical team’s best efforts, the patient continued to decline. Recognizing that her prognosis was grim, the patient chose to be discharged home with hospice with an expressed goal of spending those final days of her life with her family. Five days following discharge, she succumbed to her infection.

This case highlights the significant mortality associated with mucormycosis, no matter where or how it may initially manifest anatomically. While rare, with one study suggesting a rate of 0.12 infections per 10,000 hospital discharges(1), the overall mortality rate is estimated to be 54%(2). Clinicians must remain vigilant and recognize that though rare, the mortality rate is so significant that high-risk populations should be treated early and aggressively and, in certain cases, depending on the circumstances, pre-emptively.

References and Resources

1. Kontoyiannis DP, Yang H, Song J, et al. Prevalence, clinical and economic burden of mucormycosis-related hospitalizations in the United States: a retrospective study. BMC Infect Dis. 2016;16(1):730. Published 2016 Dec 1. doi:10.1186/s12879-016-2023-z.
2. Centers for Disease Control and Prevention. Mucormycosis Statistics. Centers for Disease Control and Prevention. Published Updated May 2020. Accessed November 11, 2023. https://www.cdc.gov/fungal/diseases/mucormycosis/statistics.html.