Post operative abdominal wall mucormycosis mimicking as bacterial necrotising fasciitis.
RM Prasad, SM Bose, K Vaiphei, GR Verma
R M Prasad
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Prasad R M, Bose S M, Vaiphei K, Verma G R. Post operative abdominal wall mucormycosis mimicking as bacterial necrotising fasciitis. J Postgrad Med 2003;49:187-8
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Prasad R M, Bose S M, Vaiphei K, Verma G R. Post operative abdominal wall mucormycosis mimicking as bacterial necrotising fasciitis. J Postgrad Med [serial online] 2003 [cited 2020 Sep 29 ];49:187-8
Available from: http://www.jpgmonline.com/text.asp?2003/49/2/187/886
A thirty-five years old non-diabetic female, who underwent epigastric herniorrhaphy in a peripheral hospital, was refered with spreading cellulitis and blackish discoloration of the wound after three days. At admission she was dehydrated, febrile and oliguric. There was a 21x12 cm. wound with necrotic floor and spreading cellulitis in the anterior abdominal wall. The rectus sheath was intact. With a clinical diagnosis of postoperative bacterial necrotising fasciitis, debridement was carried out and the excised tissue was submitted for microbiological and histopathological examination. She was put on cefotaxime, and metronidazole. Repeated debridements later resulted in removal of most of the anterior abdominal wall. The histopathology of the excised tissue showed extensive necrotizing inflammation and broad, aseptate fungal profiles of mucormycosis within the necrotic tissue. Grams stain showed gram negative bacilli and culture grew E. coli.
She was started on amphotericin-B, 50 mg/day, and increased to 75mg/day after 10 days. The disease was brought under control after 30 days of systemic amphotericin therapy. Healthy granulation tissue grew later which was covered with a split skin graft. The patient was discharged after seventy days of hospitalization.
Mucor is a zygomycetic fungus. It causes acute and rapidly progressive fungal infection usually in immunocompromised hosts but has also been reported in healthy patients like in the present case.
Abdominal wall mucormycosis develops following contamination of traumatic or surgical wounds by this opportunistic fungus either from outside or the wound may get secondarily invaded endogenously in those patients who have undergone surgery for gastrointestinal mucormycosis. In the present case fungus appears to have entered into the wound either through contaminated surgical instruments/ sutures or dressing material.
Disease is usually misdiagnosed as postoperative bacterial necrotizing fasciitis owing to its similar clinical presentation. So far only two cases of post surgical abdominal wall mucormycosis have been described.,
Early diagnosis, repeated extensive surgical debridements, administration of Amphotericin-B and broad spectrum antibiotics leads to survival in up to 73% cases. Amphotericin-B should be administered in high doses (1-1.2mg/kg/day) and continued for 2-4 weeks till the progression of disease is arrested.
It may be concluded that postoperative abdominal wall mucormycosis, though a rare disease, can be easily misdiagnosed as bacterial necrotising fasciitis. A high index of suspicion, prompt histopathological confirmation, repeated surgical debridements and amphotericin-B, are the cornerstones in the management of this disease.
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