Fungal Necrotizing Fasciitis Due to Mucormycosis Following Contaminated Substance Inoculation: A Report of Two Cases.

Abstract

Mucormycosis is a life-threatening fungal infection caused by Mucorales fungi, characterized by angioinvasion and tissue necrosis. While it predominantly affects immunocompromised individuals, it can also occur in immunocompetent patients through traumatic inoculations, such as contaminated surgical dressings or injections. We report two cases of cutaneous mucormycosis following the shared use of contaminated intramuscular corticosteroid injections (dexamethasone). Case 1 involved a 54-year-old male farmer with rapidly progressing necrotic lesions and multi-organ failure, resulting in death despite aggressive treatment. Case 2 involved a 48-year-old female nursing technician who developed similar necrotizing lesions and also succumbed to multi-organ failure after extensive debridement and antifungal therapy. These cases underscore the rapid deterioration associated with mucormycosis, an infection with a high mortality rate even in immunocompetent individuals. The hallmark of the disease is rapidly progressing necrosis due to vascular invasion and thrombosis. Mucormycosis following contaminated injections, though rare, is devastating. Early recognition and aggressive treatment, including surgical debridement and antifungal therapy, are critical but may not always prevent fatal outcomes. Strict infection prevention precautions and epidemiological surveillance are needed to prevent iatrogenic infections.

Learning points: Direct inoculation of Mucorales species through contaminated injections is a rare but serious route of infection, highlighting the importance of proper handling of medical equipment.Mucormycosis can occur in immunocompetent individuals following traumatic events or contaminated procedures, and it often leads to rapid tissue necrosis and high mortality if not promptly treated.Early surgical debridement and antifungal therapy are critical for managing mucormycosis, though survival remains poor even with aggressive intervention.