Progressive Post-traumatic Necrotizing Fasciitis in an Immunocompetent Adult Caused by Apophysomyces elegans

Volume 8 | Issue 2 | Aug – Sep 2020 | Page: 49-52 | Manoh Shanmugam, Snolin Shiromi Antonyrajan

Authors: Manoh Shanmugam [1], Snolin Shiromi Antonyrajan [2]

[1] Consultant, Nallan Speciality Hospital, Madurai, Tamil Nadu.
[2] Department of Orthopaedics, Velammal Medical College Hospital and Research Institute

Address of Correspondence
Dr. Snolin Shiromi,
5, state bank officer’s I colony, S S Colony, Madurai, Tamil Nadu 625016, India


A case of necrotizing fasciitis (NF) of the right upper limb caused by the fungi Apophysomyces elegans in an immunocompetent adult following polytrauma is reported. The probable portal of entry is abrasion with the environment being the source. Once clinically stable, the patient underwent surgical stabilization of fracture humerus and fracture clavicle. As the patient developed signs of NF in the right upper limb on the 14th post-operative day, empirical antibiotics were administered. Wound debridement was performed, and appropriate antibiotics were administered based on culture sensitivity. Since there was no clinical improvement, multiple wound debridements were performed. Amphotericin B was initiated empirically before the fungal culture report. As the wound was progressingly involving the whole limb, the patient ultimately required shoulder disarticulation. Containment of the infection with early initiation of amphotericin B and extensive wound debridements gave a positive outcome in our case. Mucormycosis should be considered a possibility in cases of NF with the progressive course and inadequate response to antibiotics.
Keywords: Necrotizing fasciitis, Amphotericin B, Mucormycosis, mucorales, Immunocompetent.


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How to Cite this article: Shanmugam M, Antonyrajan SS | Progressive Post-traumatic Necrotizing Fasciitis in an Immunocompetent Adult Caused by Apophysomyces elegans | Journal of Karnataka Orthopaedic Association | August-September 2020; 8(2): 49-52.

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