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JAMA Clinical Challenge |

Appearance of a Rapidly Expanding Facial Eschar in a Severely Injured Trauma Patient

Michael R. Christy, MD; Sachin M. Shridharani, MD
JAMA. 2012;307(10):1080-1081. doi:10.1001/jama.2012.288.
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Extract

A 21-year-old woman presents to the trauma resuscitation unit via helicopter transport following a motor vehicle crash. She was an unrestrained driver involved in a front-end collision and had a prolonged extrication from the vehicle. At the scene, she was unresponsive and underwent emergency intubation. She sustained multiple severe traumatic injuries including a ruptured spleen requiring abdominal exploration and splenectomy, atlanto-occipital dislocation requiring halo placement, bilateral pelvic fractures requiring pelvic binder, and left lower extremity crush injury with multiple open fractures ultimately requiring a left hemipelvectomy. She underwent 38 operative interventions in a 3-week period.

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Figure 1. A, 4 × 4-cm left cheek wound with exposed zygomaticus major muscle. B, Cheek wound after wide local debridement 48 hours after the original procedure.

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Figure 2. A, Biopsy of the initial lesion showing dark pink nonseptate fungal hyphae (arrowhead)(periodic acid–Schiff, original magnification ×600). B, Angioinvasive fungal hyphae (arrowhead)(periodic acid–Schiff, original magnification ×400).

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