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Primary cutaneous mucormycosis in a premature neonate responding to antigfungal therapy alone: when surgery is not an option
  1. S McCullough1,
  2. L Miall1,
  3. R Hobson2,
  4. L Elvidge3
  1. 1Neonatal Services, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  2. 2Microbiology Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  3. 3Neonatal Unit, Queens Medical Centre, Nottingham, UK

Abstract

Background Cutaneous mucormycosis is a rare opportunistic infection with a high morbidity and mortality. One case review reported a survival rate of only 39%.1 Survival depends upon early recognition, aggressive antifungal treatment and usually surgical debridement. In some cases amputation of the affected limb has been required.

There are few neonatal cases reported in the literature where systemic antifungal treatment alone resulted in survival of the premature infant. We present a case in which surgical debridement was impractical due to the position of the lesion.

Case report A female infant born at 24+3 weeks weighing 520 g. She subsequently developed coliform and then coagulase-negative staphylococcal sepsis and required antibiotics until day 18 of life. On day 15 of life due to evolving chronic lung disease, steroids were started and continued until day 36.

On day 24 of life an abscess developed on the left cheek. Despite regular washouts and 7 days of antibiotics a chronic suppurating lesion persisted. Bacterial cultures were negative and there was no rise in C reactive protein. Rhizopus arrhizus was eventually isolated from swabs and intravenous liposomal amphotericin B commenced (day 37) and given for a total of 90 days.

On review at the corrected age of 1 year there remains a significant scar on her cheek which will require serial excision.

Conclusion Our case highlights the importance of early recognition of cutaneous mucormycosis and shows that prolonged antifungal treatment alone can be effective.

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