Fatal Gastrointestinal Mucormycosis That Invaded the Postoperative Abdominal Wall Wound in an Immunocompetent Host

Especially on the immunoblot, serum levels of IgM antibody to B. burgdorferi were increased early and later decreased, whereas serum IgG antibodies remained negative (table 1). Slightly increased levels of IgM antibodies to herpesviruses and IgG antibodies were also found, however, without time-dependent changes in titers. At a follow-up 18 months after the tick bites, serological results for herpesviruses remained unchanged. Meanwhile the patient had become negative for IgM antibodies to B. burgdorferi. Because of the high risk of thrombosis or thromboembolism due to pregnancy, lumbar puncture was not carried out. Immunofluorescence assay and ELISA of umbilical cord blood from both children were negative for serum IgG and IgM antibodies, as was PCR analysis of placenta tissue for B. burgdorferi. Pregnant women have an increased risk of developing idiopathic facial nerve palsy (Bell’s palsy) [6]. The distinction between LD-associated facial palsy and Bell’s palsy is important since B. burgdorferi infection must be treated early and appropriately to ensure rapid and complete recovery [7]. Conversely, corticosteroids, which are often prescribed for treatment of Bell’s palsy, are unwarranted and perhaps deleterious in cases of infection [8]. Although Arkansas is not an area where LD is endemic (reported incidence for 1996 was 1.1 cases per 100,000 inhabitants [9]), assessment of the specific bands on the immunoblot for our patient is suggestive of true infection [8] rather than nonspecific positive results due to pregnancy. Early therapy may have prevented an IgG response. The slightly increased levels of IgM antibodies to herpesviruses suggest polyclonal stimulation rather than appearance of an acute or persistent viral infection. This case reemphasizes the fact that for pregnant women presenting with facial palsy and a history of a recent tick bite the