Cutaneous mucormycosis is a rare fungal infection caused by fungi of the order Mucorales, occurring more frequently in immunosuppressed patients or in those with uncontrolled diabetes. Although less lethal than rhino-sino-orbital and pulmonary forms, it can be severe, especially when diagnosis is delayed. We report the case of a 68-year-old woman with poorly controlled diabetes who developed an ulcerated lesion on the back after a spider bite. Initially, the lesion progressed with erythema, pain, and local edema, and she was evaluated and treated symptomatically. The lesion progressively worsened, became associated with daily fever, and the patient was hospitalized. On admission, she had an extensive ulceration with necrotic borders and intense pain, and broad-spectrum antibiotic therapy was initiated. Computed tomography showed an ulcerated lesion involving the skin, subcutaneous tissue, and trapezius muscle, measuring 11 × 11 × 2.9 cm. Surgical debridement was performed, and samples were collected for culture. Despite therapy and the procedure, lesion necrosis recurred and the patient clinically deteriorated, requiring further debridement and intensive care due to hemodynamic instability. Mycological analysis revealed hyphae compatible with Mucorales, confirming cutaneous mucormycosis. Antifungal therapy with liposomal amphotericin B was initiated, with progressive improvement of the lesion after additional debridement. However, the patient ultimately died in the ICU due to ventilator-associated pneumonia. Cutaneous mucormycosis often results from direct inoculation of fungi into traumatized areas, such as bites, wounds, or surgical sites. Diabetic patients, particularly with poor glycemic control, are at increased risk for invasive forms. Treatment requires early and aggressive management, including extensive surgical debridement and appropriate antifungal therapy, with liposomal amphotericin B as the treatment of choice. Despite these measures, morbidity and mortality remain high, especially in patients with comorbidities or significant immunosuppression. This case highlights cutaneous mucormycosis as a severe infection associated with skin trauma and risk factors such as uncontrolled diabetes. Early diagnosis and combined antifungal therapy with surgical debridement are essential for infection control.
Nascimento et al. (Sun,) studied this question.