Conclusions:
This case demonstrates a rare presentation of an angioinvasive
dermatophyte necrotizing soft tissue infection in the setting of
hematologic malignancy and increasing immunosuppression. In patients
with superficial dermatophyte infections, immunosuppression may
predispose to deeper infection and potentially angioinvasive disease. If
superficial dermatophyte lesions appear dusky with pain out of
proportion to exam, early biopsy should be pursued to assess for deeper
invasion. Early and aggressive surgical debridement with assessment and
washout of the fascial compartments can halt progression of necrotizing
soft tissue infections and result in limb salvage. This case
additionally adds to the paucity of literature on management strategies
of angioinvasive dermatophyte infections which included surgical
debridement, reduction of immunosuppression, and a 12-week course of
oral terbinafine 250 mg daily.