Cutaneous Mucormycosis in a Diabetic Patient following Traditional Dressing

Cutaneous mucormycosis is a rare manifestation of an aggressive fungal infection. Early diagnosis and treatment are vitally important in improving outcome. We report an unusual case presenting with progressive necrotizing fasciitis due to mucormycosis following trauma and dressing by man-made herbal agents. 1. Introduction Mucormycosis is a rare infection. The infection is more common among people with suppressed immune systems, but it can rarely occur in healthy people. Known risk factors for developing mucormycosis are uncontrolled diabetes mellitus, metabolic acidosis, high dose of corticosteroid, prolonged neutropenia, organ transplantation, skin trauma (cuts, scrapes, punctures, or burns), and catheter infection [1–3]. The syndromic manifestations of mucormycosis are recognized by rhinocerebral, pulmonary, gastrointestinal, dermal, or disseminated involvement [1]. Although dermal involvement rarely occurs, the instant diagnosis can lead to reduction of mortality and morbidity [1]. We report an unusual case of skin mucormycosis following trauma and bandaging by man-made herbal agents. 2. Case Report A 63-year-old poorly controlled diabetic lady treated with an oral antihyperglycemic agent (Metformin 500？mg/BD) was admitted to our hospital, with complaint of severe pain, swelling, and bruising of the left upper extremity. The patient had a history of the wrist strain about four days before admission, in avoidance of falling from a vehicle which resulted in wrist dislocation. The patient had been visited by an alternative practitioner and a wrist reduction was done unprofessionally for her. He bandaged up her wrist with some man-made herbal combination (including egg, flour, and turmeric). On the fourth day after injury, the pain was progressive despite herbal dressing and taking analgesic. Her bandage was unwrapped by her companions and because of a necrotizing region covering from her hand to forearm; she was admitted to Imam Khomeini Hospital (a 1000-bed, referral, tertiary teaching hospital, in Tehran, Iran) in September 2011. On examination, her general condition was fair, but she had a low grade fever (oral temperature = 38 degrees centigrade) and she was distressed by her left-hand pain. Her respiratory, cardiovascular systems and abdomen were within normal limit. Local examination showed hand, wrist, and forearm edema, a black skin discoloration, and cutaneous necrosis (Figure 1). The region was warm and tender without erythema or induration. Also a limitation in wrist range of motion was detected. The radial pulse was palpable, while ulnar