Use of adjuvant hyperbaric oxygen therapy in a patient with traumatic inoculation of mucormycosis resulting in extremity amputation

A 64-year-old man with uncontrolled diabetes mellitus presented to the emergency department with worsening left lower extremity pain, hypotension, fever and altered mental status (figure 1). Eleven days prior, he was involved in a motorcycle collision wherein he underwent internal fixation of his distal left fibula and pinning of his left metatarsals. Given his overlying cellulitis and septic shock, our surgical team was consulted immediately for the presumptive diagnosis of necrotizing fasciitis. He was started on broad spectrum antibiotics and taken for emergent surgical debridement. The underlying suspicion was that the infection had spread to his knee joint, so the proximal extent of his subcutaneous debridement extended to his femur. His cultures grew E nterococcus f a e calis ; however, despite culture-directed antibiotic therapy and multiple subsequent debridements, his infectious course persisted, and he even required an above knee amputation. Below is a photograph of his wound. Figure 1 Lower extremity amputation stump site. What would you do next? 1. More aggressive debridement and hip disarticulation if needed. 2. Topical rifampin powder …