A multimodal approach for mucormycosis osteomyelitis of the hand: Case report

Abstract

Background: Osteoarticular mucormycosis is an aggressive process, with destruction that often necessitates amputations. Immunocompromised patients have a high morbidity and mortality rate, and recovery is often dependent on recovery of T-cell function and correction of neutropenia. This case report describes an adolescent patient who developed Mucor osteomyelitis of the right hand, with the goal of describing a successful limb-sparing medical-surgical treatment approach involving coordination.Case Report:A 16-year-old female underwent consolidative haploidentical hematopoietic stem cell transplant. Following anti-TNF therapy for concern of pulmonary pathology, she developed recurrent right wrist pain and swelling, with radiographic and surgical evidence of Rhizopus spp. osteomyelitis with necrosis of the fourth and fifth metacarpal bases and hamate. Due to radiographic and clinical progression on systemic liposomal amphotericin B and posaconazole, she received combined systemic therapy supplemented with intra-operatively placed amphotericin B and antibiotic beads changed at regular surgical debridement over 6 weeks. The patient had preserved motor and sensory function throughout with no further signs of osteomyelitis on follow-up. Conclusion: Early diagnosis and aggressive anti-fungal therapy with coordination of surgical debridement and amphotericin cement bead drug delivery can allow for a robust treatment response.