From traumatic necrotizing fasciitis to central nervous system involvement: Expanding the clinical spectrum of Apophysomyces variabilis

ABSTRACT

Species belonging to the genus Apophysomyces are thermotolerant filamentous fungi within the order Mucorales and family Mucoraceae . These organisms have increasingly been recognized as clinically significant pathogens due to their ability to cause severe, often fatal invasive infections. While Apophysomyces species classically cause post-traumatic necrotizing soft-tissue infections in immunocompetent individuals, central nervous system involvement is rare and typically reported in immunocompromised hosts. This case series uniquely juxtaposes two distinct clinical presentations of Apophysomyces infection: post-traumatic necrotizing fasciitis and neurological infection in a patient with cancer. These cases underscore the broad clinical spectrum of the disease and highlight the diagnostic challenges associated with Apophysomyces infections. The definitive diagnosis of these infections continues to rely primarily on fungal culture and histopathology, with molecular methods increasingly used to complement conventional approaches. Early recognition, timely microbiological diagnosis, and prompt antifungal therapy combined with surgical management are critical.