ABSTRACT Cutaneous mucormycosis is a rare invasive fungal infection caused by fungi of the order Mucorales. Although it classically occurs in immunocompromised hosts, traumatic or minor cutaneous inoculation may result in infection even in patients without active immunosuppression. Because vascular invasion may lead to rapidly progressive necrosis, cutaneous mucormycosis can clinically resemble necrotizing soft‐tissue infection. A 70‐year‐old man with a history of laryngeal carcinoma in remission and no active immunosuppressive treatment presented with 1 week of progressive pain, swelling, discoloration, and necrotic lesions of the left leg. Necrotizing fasciitis was clinically suspected because of severe pain, extensive hemorrhagic necrosis along the fascia, and deep soft‐tissue involvement; however, no computed tomography or magnetic resonance imaging was performed. Tissue sampling showed broad, pauciseptate hyphae with right‐angle branching on direct microscopy, and fungal culture grew Mucorales species. Liposomal amphotericin B was initiated at 5 mg/kg/day, but treatment was discontinued after serum creatinine increased from 0.81 to 2.5 mg/dL despite hydration. Intravenous posaconazole was started, followed by oral posaconazole delayed‐release tablets after discharge. Therapeutic drug monitoring was not available. Serial debridements, antifungal therapy, and subsequent skin grafting resulted in clinical recovery without relapse during follow‐up. This case highlights that cutaneous mucormycosis may present with necrotizing deep soft‐tissue involvement and clinically mimic necrotizing fasciitis. The case also underlines the need to avoid overstatement of host immune status when advanced age and previous malignancy are present. Early surgical management, tissue‐based mycological diagnosis, and prompt antifungal therapy remain essential; posaconazole is a useful step‐down or salvage option when amphotericin B toxicity limits treatment, but formulation and therapeutic drug monitoring should be considered.
İnan et al. (Mon,) studied this question.