TITLE:
Fungal Carbuncle Due to Apophysomyces elegans—A Case Report
AUTHORS:
Dev Merlin Samuel, Narayanasami Bharath, Manoj Prabu, Khalilur Rahman, Arcot Rekha
KEYWORDS:
Mucormycosis, Deep Seated Cutaneous Fungal Infections, Apophysomyces elegans
JOURNAL NAME:
Case Reports in Clinical Medicine,
Vol.8 No.1,
January
21,
2019
ABSTRACT: Background: Deep seated cutaneous fungal infection is a rare entity in surgical practice and is very often under diagnosed. Due to the atypical presentation and slow but aggressive progression of the disease, the associated mortality is high. Aim: The aim of this article to update clinicians about the peculiar presentation of mucormycosis caused by Apophysomyces elegans. Case Presentation: A 50 year old gentleman with a painful swelling and fever was admitted into our care. He had history of trivial trauma and no medical comorbid. His initial labs came back relatively unremarkable. He did not respond to an empirical antibacterial regimen and progressively worsened. The region was debrided and found to have granular secretions with sloughed tissue. On opening the dressing post operatively, a fungal mould was found. Fungal etiology was suspected and KOH mount confirmed the diagnosis. He was started on empirical IV antifungals, and local therapy while awaiting culture and sensitivity reports. However, he progressively deteriorated and succumbed to the disease eventually. Conclusion: Here we describe a deep seated cutaneous fungal infection in an immunocompetent patient and the challenges we faced during the course of his management. Fungal etiology is generally encountered in immunocompromised hosts. Deep seated cutaneous fungal infections with poor response to antifungal therapy and systemic sepsis led to this patients’ demise. This being the case, the onus is on the clinicians to diagnose a fungal etiology early and start appropriate anti fungal measures.