Cutaneous mucormycosis is a highly fatal infection increasingly seen after severe trauma. We present a previously healthy 45-year-old man who developed an invasive Rhizopus microsporus infection following a haystack crush injury. Initially treated for crush syndrome and acute kidney injury (AKI), he developed distinct right temple necrosis on hospital day 13. Immediate debridement exposed bone involvement. Notably, standard serum (1,3)-β-D-glucan and galactomannan tests were non-contributory in this case and did not exclude mucormycosis. However, histopathology and targeted next-generation sequencing (tNGS) confirmed R. microsporus . Navigating his AKI, we utilized a renal-sparing approach: systemic amphotericin B cholesteryl sulfate complex (ABCD) combined with topical amphotericin B wound dressings. He later successfully stepped down to oral isavuconazole. At the 3-month post-discharge follow-up, the infection had entirely resolved with excellent granulation. This case highlights a critical clinical trap: standard serum (1,3)-β-D-glucan and galactomannan tests can remain completely negative in mucormycosis. Clinicians must rely on early pathology and tNGS for trauma-induced necrosis. Furthermore, coupling aggressive debridement with combined systemic and topical antifungal therapy may represent a useful management strategy in selected critically ill patients with renal impairment.
Yan et al. (Wed,) studied this question.