Primary Cutaneous Mucormycosis Caused by Apophysomyces elegans in an Immunocompetent Child: A Rare Pediatric Case Report
TL;DR
This case illustrates that invasive fungal infections can be encountered even in immunocompetent children after minor trauma, and Prompt and aggressive combined medical-surgical management and early suspicion is vital to survival.
Abstract
Background & Objective Primary cutaneous mucormycosis is an uncommon invasive fungal infection that typically occurs in immunocompromised persons. Apophysomyces elegans is a member of order Mucorales and is an emerging pathogen that can cause severe soft tissue infections in immunocompetent individuals following minor trauma. Pediatric cases in immunocompetent children are exceedingly rare. Case Presentation We describe a healthy boy aged 9 years who presented with a progressive painful swelling and black discoloration of the right lower limb after a minor incident outdoors. The first treatment with oral antibiotics didn't work. On examination, it was found that there was necrotic eschar with surrounding erythema and tenderness. Laboratory exams were normal and HIV testing was negative. MRI showed soft tissue involvement in the absence of bone invasion. Direct potassium hydroxide (KOH) mount showed broad aseptate hyphae and fungal culture produced the growth of Apophysomyces elegans. Urgent surgical debridement and intravenous (IV) liposomal amphotericin B were performed. He improved markedly clinically and was discharged on oral posaconazole for 6 weeks. At 3-month follow-up, there were no recurrences. Conclusion This case illustrates that invasive fungal infections can be encountered even in immunocompetent children after minor trauma. Prompt and aggressive combined medical-surgical management and early suspicion is vital to survival.