A Multimodal Anti-fungal and Surgical Approach to Optimize Anatomic and
Functional Recovery in Zygomycetes Osteomyelitis of the Hand
Abstract
Osteoarticular mucormycosis is relentlessly progressive, with bone
destruction that necessitates extremity amputation. This case reports a
16-year-old female with pre-B cell acute lymphoblastic leukemia (B-cell
ALL) who underwent consolidative haploidentical hematopoietic stem cell
transplantation (HSCT) and developed Zygomycetes spp. osteomyelitis
after receiving anti-TNF therapy for presumed pulmonary GVHD. Due to
progression on systemic therapy, she received the adjunct of
intra-operatively placed amphotericin B cement beads changed at regular
surgical debridement over 6 weeks. This case demonstrates that early
diagnosis and aggressive anti-fungal therapy with surgical debridement
and amphotericin cement beads can allow limb sparing and complete
recovery.