Cutaneous mucormycosis as result of insulin administration in an AML patient: Case report and review of the literature

Abstract

We present a case of cutaneous mucormycosis in a patient with several important risk factors precipitating disease, namely underlying acute myeloid leukaemia and poorly controlled secondary diabetes. Inoculation was most likely caused by repeated minor trauma (insulin injection) at the site of infection. Treatment consisted of surgical debridement and liposomal Amphotericin B (LAmB) during 71 days. Posaconazole had already been initiated prior to infection as primary antifungal prophylaxis but was discontinued during follow-up as susceptibility testing later revealed resistance to posaconazole. Additional treatment with caspofungin and G-CSF was associated because of poor initial result to treatment. Caspofungin was later continued as monotherapy when LAmB had to be interrupted because of renal toxicity. Treatment was completed after closure of the surgical site. The patient was successfully treated and remains infection free for one year after initial diagnosis.

Keywords: Acute myeloid leukaemia; Diabetes; Mucomycosis; Rhizopus microsporus; Zygomycosis.