A case report of Saksenaea vasiformis mucormycosis infection of a lower segment caesarean section wound.

Abstract

<h4>Introduction</h4>Mucormycosis is a rare and difficult condition to diagnose, often requiring histological confirmation. Only two previous case reports of mucormycosis infections following caesarean section have been published to date.<h4>Case presentation</h4>A 24-year-old female from Australia presented with fevers, pain and discharge from her wound site seven days following a lower segment caesarean section. The patient failed to improve with broad-spectrum antibiotics and required radical surgical debridement. Tissue samples from the first debridement operation found necrotic fibroadipose tissue with fungal hyphae histologically. The hyphae were 90-degree branching with focal angioinvasion, a highly suggestive feature of mucormycosis, which eventually identified Saksenaea vasiformis.<h4>Discussion</h4>The mucormycosis infection was treated with amphotericin B and posaconazole as well as multiple surgical debridement operations. Following resolution of the infection, reconstruction was performed with Phasix™ mesh repair of the abdominal fascia, in addition to biodegradable temporizing matrix (BTM) and split-thickness skin grafting.<h4>Conclusion</h4>This case highlights the exceptionally rare diagnosis of mucormycosis in a caesarean section wound, especially in a developed country, and the complex multidisciplinary management required. Antifungal treatment and aggressive radical debridement were essential for treatment, as well as reconstruction in an infected setting.