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Surgical Management and Use of Irrigating Negative Pressure Wound Therapy for Invasive Exophiala jeanselmei of the Lower Extremity
Anthony DeLeonibus MD, Christina Dami Lee DO, Morgan Fish MD, Christi Cavaliere MD
Cleveland Clinic
2021-02-15
Presenter: Anthony DeLeonibus
Affidavit:
The material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting.
Director Name: Steven Bernard
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Opportunistic chromoblastomycosis infections have increased in incidence over the past decades due to the introduction of robust transplant and autoimmune immunosuppressive regimens. With the introduction of these medications, dematiaceous black mold fungal infections such as Exophiala species have established invasive subcutaneous growth without a consensus on medical management or surgical intervention. This report and review of the literature for surgical management of Exophiala aimed to establish a surgical treatment review of the literature and aid clinicians with a new tool for localized treatment.
This case involved a 66 year-old-male who was status post heterotopic living donor liver and living donor kidney allotransplantations. His post transplant course was complicated by an indolent culture-proven Exophiala jeanselmei infection of his left lower extremity in three locations involving the Achilles tendon. After two surgical debridements, the tendon was able to be preserved but remained at risk of recurrent infection. The decision to not excise his Achilles was weighed against the risk of incomplete fungal control. In order to combat any remaining infectious fungal elements, the use of an amphotericin irrigating negative pressure wound therapy was utilized to treat the infection locally as an adjunct to systemic itraconazole and terbinafine.
Surgical excision of the mass is often necessary due to difficulty obtaining targeted antifungal coverage or localized antifungal treatment at the area in question. Due to adverse effects in effective systemic treatment, this was the first reported use of an irrigating negative pressure wound device to deliver direct antifungal treatment at the site of infection.
