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A Multimodal Anti-fungal and Surgical Approach to Optimize Anatomic and Functional Recovery in Zygomycetes Osteomyelitis of the Hand
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  • Madhuri Kashyap,
  • Brandon Chatani,
  • Harsh Shah,
  • Chanique James,
  • Ali Saad,
  • Juan Infante,
  • Seth Dodds,
  • Asha Pillai
Madhuri Kashyap
Jackson Memorial Hospital
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Brandon Chatani
University of Miami Miller School of Medicine
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Harsh Shah
University of Miami Miller School of Medicine
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Chanique James
Jackson Memorial Hospital
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Ali Saad
Holtz Children's Hospital
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Juan Infante
Nemours Children's Health System
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Seth Dodds
University of Miami Miller School of Medicine
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Asha Pillai
Holtz Children's Hospital

Corresponding Author:[email protected]

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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.