An unexpected case of disseminated mucormycosis following pacemaker placement and brief course of oral corticosteroids

Mucormycosis is a rare opportunistic fungal infection with a high degree of morbidity and mortality. It classically presents with rapidly progressing, necrotic rhinocerebral mucocutaneous lesions in the setting of an immunocompromised host, especially with concomitant uncontrolled diabetes. We report the case of a 67-year-old man with well-controlled non-insulin dependent diabetes and brief steroid exposure who presented in sepsis with a tender posterior shoulder skin lesion. The initial lesion enlarged and progressed over several days, developing central areas of ecchymosis and bullae, with several other large lesions appearing at various distant sites. He also experienced an array of systemic symptoms, including fever, malaise, weakness, and acute encephalopathy. A diagnosis of mucor was made by histopathological examination of the initial skin lesion. Despite initiation of amphotericin B and aggressive surgical debridement including transfer to specialist tertiary burn center, the patient passed away less than a week after definitive diagnosis. This is a unique case of disseminated mucormycosis given his lack of chronic immunosuppression or uncontrolled diabetes, and with no risk factors for inoculation except for pacemaker placement 2 months prior to admission. The case highlights the importance of considering mucormycosis in the early differential diagnosis of rapidly progressing skin lesions, as rapid detection and treatment is critical to mitigate the deadly effects of this fast-moving fatal fungus. Moreover, the case serves as a testament to the unpredictable progression of disseminated disease, while also demonstrating an unusual potential mode of introduction and a rare but fatal consequence of prescribing corticosteroids in an infected host.