Abstract
We describe a case of nosocomial mucormycosis of the thigh in an immunocompromised patient admitted with COVID-19 acute respiratory distress syndrome.
Keywords: Mucormycosis, COVID-19, musculoskeletal, Cutaneous, Fungi, Immunocompromised
A necrotic skin lesion developed in a 54-year-old man admitted to the intensive care unit with acute respiratory distress syndrome (ARDS) caused by COVID-19. The lesion occurred at the site of a thigh hematoma caused by arterial line insertion one month earlier. The patient was known for diffuse large B-cell lymphoma and had received chimeric antigen receptor T cells 7 months prior to presentation. He was receiving dexamethasone and was on veno-venous extracorporeal membrane oxygenation (ECMO) for COVID-19 ARDS. Physical examination demonstrated a 23.5-centimeter x 13-centimeter necrotic eschar superimposed by white mycelium (Fig. 1). Culture of the mycelium grew Rhizopus species, within the Mucorales fungal order. The patient was started on amphotericin B deoxycholate and posaconazole and taken urgently to the operating room for debridement. Intraoperative assessment demonstrated deep fungal tissue invasion (Fig. 2). The patient died 24 h after surgery.
Fig. 1.
Necrotic eschar of the thigh with arrow demonstrating white mycelium.
Fig. 2.
Deep debridement was necessary to remove infected necrotic tissue.
Source of funding
No sources of funding.
Ethical approval
N/A.
Consent
Patient consent was obtained.
Author contribution
MC was responsible for the conceptualization of the piece and taking the photos and editing the manuscript. CB wrote the initial manuscript. Both authors cared for the patient in question.
Author statement
No funding of any kind was received by any of the authors for this project.
The authors have no competing interests or financial interests in this article. There are no academic commitments, personal relationships, political/religious beliefs or institutional affiliations that interfere with the publication of this paper. Consent was obtained for the publication of this case.
Declaration of Competing Interest
The authors report no declarations of interest.