Case Report
Two Cases of Post-Traumatic Mucormycosis due to Mucor
circinelloides: Salvage Therapy with a Combination of
Adjunctive Therapies
A. De Paepe,
1
K. Dams ,
1
D. Robert,
1
R. Jacobs,
1
G. L. Ten Kate ,
2
S. Van Ierssel,
2
H. Jansens,
3
M. Lammens,
4
A. Van Beeck,
5
and P. G. Jorens
1
1
Departments of Critical Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
2
Departments of Infectious Diseases, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
3
Departments of Microbiology, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
4
Departments of Pathology, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
5
Departments of Orthopaedics, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
Correspondence should be addressed to P. G. Jorens; philippe.jorens@uza.be
Received 3 February 2022; Accepted 6 April 2022; Published 4 May 2022
Academic Editor: Fariborz Mansour-Ghanaei
Copyright © 2022 A. De Paepe et al. is is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Mucormycosis is a rare, emerging angioinvasive infection caused by ubiquitous filamentous fungi. In recent decades, an increase
in cutaneous or post-traumatic mucormycosis has been reported. We describe two cases of post-traumatic wound infections with
Mucor circinelloides, a mucor species only rarely reported as a cause of post-traumatic mucormycosis. Often considered lethal,
management required a combination of medical and surgical therapies to achieve a favorable outcome in both cases.
1. Introduction
Mucormycosis is an aggressive fungal disease caused by
members of the phylum Glomeromycota, subphyla Mucor-
omycotina and Entomophtoromycotina (formerly phylum
Zygomycota, orders of Mucorales and Entomophthorales)
[1–3]. Most frequently, mucormycosis is a disease of an im-
munocompromised host, either due to hematological malig-
nancy, hematopoietic stem cell or solid organ transplantation,
or poorly controlled diabetes mellitus, especially in the presence
of diabetic ketoacidosis [4]. More recently, COVID-19 and the
associated treatment with corticosteroids were also identified as
risk factors for the development of mucormycosis [5]. e
disease has various presentations: rhino-orbito-cerebral, pul-
monary, cutaneous, gastrointestinal, or disseminated disease.
Cutaneous disease, although rare, also occurs in immuno-
competent hosts, especially following trauma [6].
In this report, we describe two cases of post-traumatic
mucormycosis due to infection with Mucor circinelloides in
two road traffic accident victims.
2. Case 1 and 2
In the first case, the proven invasive fungal disease was
confirmed by histopathology (presence of hyphae and ne-
crotic tissue), whereas in the second case diagnosis was based
on the clinical picture and tissue culture of bone and muscle.
Histopathology showed muscle necrosis without the pres-
ence of hyphae [7]. e cultures were sent to the national
reference center for invasive fungal disease for identification
(matrix-assisted laser desorption/ionization time of flight
(MALDI-TOF) and mass spectrometry identification (MSI)
platform) and susceptibility testing (E-test). is mucor
species has rarely been detected in humans after trauma or in
cutaneous infections. Effective management required re-
peated surgical debridement, conventional antifungal
therapy, and a combination of adjunctive therapies.
2.1. Case 1 Presentation. A 20-year-old, previously healthy
male patient suffered from a road traffic accident. He was hit
by a truck with a subsequent fall off a bridge and landed in
Hindawi
Case Reports in Infectious Diseases
Volume 2022, Article ID 4949426, 8 pages
https://doi.org/10.1155/2022/4949426