A multimodal approach for mucormycosis osteomyelitis of the hand: Case report
Background: Osteoarticular mucormycosis is an aggressive process, with destruction that often necessitates amputations. Immunocompromised patients have a high morbidity and mortality rate, and recovery is often dependent on recovery of T-cell function and correction of neutropenia. This case report...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-09-01
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| Series: | Journal of Orthopaedic Reports |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2773157X24000122 |
| _version_ | 1827125250217738240 |
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| author | Harsh A. Shah Madhuri Kashyap Seth D. Dodds Asha B. Pillai |
| author_facet | Harsh A. Shah Madhuri Kashyap Seth D. Dodds Asha B. Pillai |
| author_sort | Harsh A. Shah |
| collection | DOAJ |
| description | Background: Osteoarticular mucormycosis is an aggressive process, with destruction that often necessitates amputations. Immunocompromised patients have a high morbidity and mortality rate, and recovery is often dependent on recovery of T-cell function and correction of neutropenia. This case report describes an adolescent patient who developed Mucor osteomyelitis of the right hand, with the goal of describing a successful limb-sparing medical-surgical treatment approach involving coordination.Case Report:A 16-year-old female underwent consolidative haploidentical hematopoietic stem cell transplant. Following anti-TNF therapy for concern of pulmonary pathology, she developed recurrent right wrist pain and swelling, with radiographic and surgical evidence of Rhizopus spp. osteomyelitis with necrosis of the fourth and fifth metacarpal bases and hamate. Due to radiographic and clinical progression on systemic liposomal amphotericin B and posaconazole, she received combined systemic therapy supplemented with intra-operatively placed amphotericin B and antibiotic beads changed at regular surgical debridement over 6 weeks. The patient had preserved motor and sensory function throughout with no further signs of osteomyelitis on follow-up. Conclusion: Early diagnosis and aggressive anti-fungal therapy with coordination of surgical debridement and amphotericin cement bead drug delivery can allow for a robust treatment response. |
| first_indexed | 2024-03-07T23:38:02Z |
| format | Article |
| id | doaj.art-15c88a7193bc42f8aaf3b1a34b385f88 |
| institution | Directory Open Access Journal |
| issn | 2773-157X |
| language | English |
| last_indexed | 2025-03-20T14:53:43Z |
| publishDate | 2024-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Orthopaedic Reports |
| spelling | doaj.art-15c88a7193bc42f8aaf3b1a34b385f882024-09-07T04:49:59ZengElsevierJournal of Orthopaedic Reports2773-157X2024-09-0133100317A multimodal approach for mucormycosis osteomyelitis of the hand: Case reportHarsh A. Shah0Madhuri Kashyap1Seth D. Dodds2Asha B. Pillai3Jackson Memorial Hospital System, Miami, FL, 33136, USA; Leonard M. Miller School of Medicine, University of Miami, Miami, FL, 33136, USA; Department of Orthopedics, Division of Hand Surgery, Miami, FL, 33136, USA; Corresponding autho. Jackson Memorial Hospital System, Miami, FL, 33136, USA.Jackson Memorial Hospital System, Miami, FL, 33136, USA; Leonard M. Miller School of Medicine, University of Miami, Miami, FL, 33136, USAJackson Memorial Hospital System, Miami, FL, 33136, USA; Leonard M. Miller School of Medicine, University of Miami, Miami, FL, 33136, USA; Department of Orthopedics, Division of Hand Surgery, Miami, FL, 33136, USA; Corresponding author. University of Miami, Department of Orthopaedics, 1120 NW 14th Street, Suite 1263, Miami, FL, 33136, USA.Jackson Memorial Hospital System, Miami, FL, 33136, USA; Leonard M. Miller School of Medicine, University of Miami, Miami, FL, 33136, USA; Department of Pediatrics, Division of Hematology/Oncology/BMT, Miami, FL, 33136, USA; Sylvester Comprehensive Cancer Center, Miami, FL, 33136, USABackground: Osteoarticular mucormycosis is an aggressive process, with destruction that often necessitates amputations. Immunocompromised patients have a high morbidity and mortality rate, and recovery is often dependent on recovery of T-cell function and correction of neutropenia. This case report describes an adolescent patient who developed Mucor osteomyelitis of the right hand, with the goal of describing a successful limb-sparing medical-surgical treatment approach involving coordination.Case Report:A 16-year-old female underwent consolidative haploidentical hematopoietic stem cell transplant. Following anti-TNF therapy for concern of pulmonary pathology, she developed recurrent right wrist pain and swelling, with radiographic and surgical evidence of Rhizopus spp. osteomyelitis with necrosis of the fourth and fifth metacarpal bases and hamate. Due to radiographic and clinical progression on systemic liposomal amphotericin B and posaconazole, she received combined systemic therapy supplemented with intra-operatively placed amphotericin B and antibiotic beads changed at regular surgical debridement over 6 weeks. The patient had preserved motor and sensory function throughout with no further signs of osteomyelitis on follow-up. Conclusion: Early diagnosis and aggressive anti-fungal therapy with coordination of surgical debridement and amphotericin cement bead drug delivery can allow for a robust treatment response.http://www.sciencedirect.com/science/article/pii/S2773157X24000122 |
| spellingShingle | Harsh A. Shah Madhuri Kashyap Seth D. Dodds Asha B. Pillai A multimodal approach for mucormycosis osteomyelitis of the hand: Case report Journal of Orthopaedic Reports |
| title | A multimodal approach for mucormycosis osteomyelitis of the hand: Case report |
| title_full | A multimodal approach for mucormycosis osteomyelitis of the hand: Case report |
| title_fullStr | A multimodal approach for mucormycosis osteomyelitis of the hand: Case report |
| title_full_unstemmed | A multimodal approach for mucormycosis osteomyelitis of the hand: Case report |
| title_short | A multimodal approach for mucormycosis osteomyelitis of the hand: Case report |
| title_sort | multimodal approach for mucormycosis osteomyelitis of the hand case report |
| url | http://www.sciencedirect.com/science/article/pii/S2773157X24000122 |
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