Insulin Needle Reuse Leads to Serious Fungal Infection in Immunocompromised Patient

Insulin needle reuse could potentially lead to severe infection, particularly in immunocompromised patients, as illustrated in a recent case report involving a patient who developed abdominal primary cutaneous mucormycosis.

The 71-year-old female patient, who had insulin-dependent type 2 diabetes as well as metastatic squamous cell carcinoma of the lung, presented to the emergency room with a necrotic lesion located on the left lower quadrant of her abdomen. One week prior to admission, the patient received trimethoprim-sulfamethoxazole for suspected cellulitis after she observed an “erythematous non-pruritic eruption” on her abdomen. 

Although she completed the course of antibiotics, a blister had formed and erupted, leaving a solitary stellate necrotic plaque. The plaque, which was approximately 6cm, had hemorrhagic vesiculation at the borders and was erythemic. After obtaining a more detailed history, it was discovered that the patient had been reusing insulin needles and was not rotating sites for insulin injection.

“The patient was evaluated by the dermatology service and a punch biopsy was performed demonstrating numerous fungal hyphae, broad and aseptate, with right angle branching and prominent angioinvasion with associated microvascular thrombosis most consistent with mucormycosis,” the authors stated. A culture of the wound came back positive for Mucor as well as methicillin-resistant Staphylococcus aureus. 

The patient was treated with isavuconazole and underwent incision as well as debridement of the lesion. After surgery, a wound vac was placed and the patient received a 14-day course of vancomycin. The plan was for the patient to complete an additional course of isavuconazole, however, prior to discharge, she developed increased intracranial swelling caused by multiple cerebral metastases. After being intubated and having an external ventricular drain placed while in the intensive care unit, the patient was transferred home with hospice until her death. Further debridement of the wound and antifungal medication were declined at the time. 

“Mucormycosis is an invasive fungal infection that most often affects immunocompromised individuals, particularly patients with uncontrolled diabetes mellitus, through penetrating trauma to the skin,” the authors stated. They added, “Although insulin needle reuse may be a viable option in select patients, patient education around needle reuse is paramount, particularly in patients who are immunosuppressed.”

Reference

Perz A, Makar G, Fernandez E, Weinstock, J, and Rafferty W. Primary cutaneous mucormycosis of the abdomen at the site of repeated insulin injections. BMJ Case Reports. doi: 10.1136/bcr-2019-233284.

This article originally appeared on MPR