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 , Snolin Shiromi Antonyrajan 
 Consultant, Nallan Speciality Hospital, Madurai, Tamil Nadu.
 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.
1. Puvanendran R, Huey JC, Pasupathy S. Necrotizing fasciitis. Can Fam Physician 2009;55:981-7.
2. Fontes RA Jr., Ogilvie CM, Miclau T. Necrotizing soft-tissue infections. J Am Acad Orthop Surg 2000;8:151-8.
3. Green RJ, Dafoe DC, Raffin TA. Necrotizing fasciitis. Chest 1996;110:219-29.
4. Sridhara SR, Paragache G, Panda NK, Chakrabarti A. Mucormycosis in immunocompetent individuals: An increasing trend. J Otolaryngol 2005;34:402-6.
5. Frater JL, Hall GS, Procop GW. Histologic features of zygomycosis: Emphasis on perineural invasion and fungal morphology. Arch Pathol Lab Med 2001;125:375-8.
6. Gomes ZR, Lewis RE, Kontoyiannis DP. Mucormycosis caused by unusual mucormycetes, Non-Rhizopus, -Mucor, and-Lichtheimia species Marisa. Clin Microbiol Rev 2011;24:411-45.
7. Kordy FN, Al-Mohsen IZ, Hashem F, Almodovar E, Al Hajjar S, Walsh TJ. Successful treatment of a child with posttraumatic necrotizing fasciitis caused by Apophysomyces elegans: Case report and review of literature. Pediatr Infect Dis J 2004;23:877-
8. Chakrabarti A, Chatterjee SS, Das A, Panda N, Shivaprakash MR, Kaur A, et al. Invasive zygomycosis in India: Experience in a tertiary care hospital. Postgrad Med J 2009;85:573-81.
9. Chander J, Stchigel AM, Alastruey-Izquierdo A, Jayant M, Bala K, Rani H, et al. Fungal necrotizing fasciitis, an emerging infectious disease caused by Apophysomyces (Mucorales). Rev Iberoam Micol 2015;32:93-8.
10. Mathews MS, Raman A, Nair A. Nosocomial zygomycotic post-surgical necrotizing fasciitis in a healthy adult caused by Apophysomyces elegans in South India. J Med Vet Mycol 1997;35:61-3.
11. Wang J, Harvey CM, Calhoun JH, Yin LY, Mader JT. Systemic Apophysomyces elegans after trauma: Case report and literature review. Surg Infect (Larchmt) 2002;3:283-9.
12. Chakrabarti A, Ghosh A, Prasad GS, David JK, Gupta S, Das A, et al. Apophysomyces elegans: An emerging zygomycete in India. J Clin Microbiol 2003;41:783-8.
13. Lakshmi V, Rani TS, Sharma S, Mohan VS, Sundaram C, Rao RR, et al. Zygomycotic necrotizing fasciitis caused by Apophysomyces elegans. J Clin Microbiol 1993;31:1368-9.
14. Chakrabarti A, Das A, Sharma A, Panda N, Das S, Gupta KL, et al. Ten years’ experience in zygomycosis at a tertiary care Centre in India. J Infect 2001;42:261-6.
15. Cáceres AM, Sardiñas C, Marcano C, Guevara R, Barros J, Bianchi G, et al. Apophysomyces elegans Limb infection with a favorable outcome: Case report and review. Clin Infect Dis 1997;25:331-2.
16. Wieden MA, Steinbronn KK, Padhye AA, Ajello L, Chandler FW. Zygomycosis caused by Apophysomyces elegans. J Clin Microbiol 1985;22:522-6.
|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.|
Leave a ReplyWant to join the discussion?
Feel free to contribute!