Prise en charge d'une mucormycose disséminée chez un patient polytraumatisé et brûlé: intérêt des instillations locales, rapport de cas et revue de la littérature.

Mucormycosis are infrequent filamentous fungal infections, but severe and with high mortality (20 to 50%). Symptoms are very common, like necrosis, and burn/polytrauma patients have a higher risk of mucormycosis than the general population. We report here the history of a 38-year-old man, polytraumatized and burned because of a tractor incident. During the first two weeks two haemorrhagic shock episodes occurred because of necrosis of the humeral artery. Analysis of vascular fragment identified Lichteimia spp. The diagnosis of invasive infection was established after identifying Lichteimia spp. in blood cultures also. We treated the patient with intravenous liposomal amphotericin, oral posaconazole and surgical debridement according to the gold standard. The wound mucormycosis was also treated with a humeral bypass with vascular allograft and a latissimus dorsi pedicled flap. Furthermore, mucormycosis was treated with local instillations of amphotericin B in the dressings twice a day with 1% (1 mg/100mL) solution of non-liposomal amphotericin. Early diagnosis and treatment is very important for mucormycosis healing and to minimize morbimortality. With burn and polytrauma patients necrosis and bad local evolution have to be carefully screened and analyzed.