Trychophyton Species As The Cause of Diabetic Foot Infection: A Case Report

Bacterial diabetic foot infections commonly present with Staphylococcus species, however Trychophyton species in a soft tissue abscess of the foot is a rare finding. We present an unusual case of a 39-year old male patient with poorly controlled Type 2 diabetes, status post MI, who presented to the ED with an infected chronic plantar right foot wound. Empiric IV antibiotics were started, and right foot MRI was done showing osteomyelitis of the bases of the 4th and 5th proximal phalanges as well as the head of the 4th metatarsal. He underwent irrigation and debridement of the wound with resection of the infected bone, however post op day one he continued with severe foot edema, erythema, and purulence from the operative foot. CT and MRI were performed showing a possible plantar abscess. He underwent repeat incision and drainage with continued IV antibiotics , however little to no improvement was noted. Bacterial cultures grew several bacterial species thus more IV targeted antibiotics were administered. He underwent several more debridements before mold was identified from an intra-operative soft tissue culture. After the mold was cultured , the operative procedure was changed to include irrigation with saline, and Amphotericin B powder in addition to cement beads impregnated with Amphotericin B powder. Patient was started on IV Cresemba which he received for 6 weeks. He continued with local wound care, and offloading of the foot making full recovery several weeks later. Fungal mold infections in soft tissue are more commonly identified in burn patients, however less commonly the cause of diabetic foot infections.

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