A rare case of gastric mucormycosis in an immunocompetent patient

Abreu, Bruno Fernandes Barros Brehme de; Duarte, Márcio Luí­s; Santos, Lucas Ribeiro dos; Sementilli, Ângelo; Figueiras, Felipe Nunes

doi:10.1590/0037-8682-0304-2017

Cited by 10 publications

(7 citation statements)

References 5 publications

(12 reference statements)

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“…Similar to the findings of a case report published by Abreu et al . [ 18 ], our positive patient outcomes suggest that increased reporting and awareness of fungal infections in immunocompetent adults may lead to early administration of antifungal drugs, early surgical treatment, and better outcomes. If fungal infection is suspected according to clinical diagnosis, surgical treatment could be considered to eradicate the primary lesion, which may increase the patient's chance of cure.…”

Section: Discussionmentioning

confidence: 98%

Mucormycosis-induced upper gastrointestinal ulcer perforation in immunocompetent patients: a report of two cases

et al. 2021

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Background Gastrointestinal mucormycosis (GIM) is a rare, opportunistic fungal infection with poor prognosis. Clinically, it is difficult to diagnose GIM owing to its nonspecific clinical symptoms and poor suspicion. The estimated incidence of GIM is inaccurate, and most cases are diagnosed accidentally during surgery or upon postmortem examination. GIM usually occurs in patients with immune deficiencies or diabetes. Here, we report two cases of immunocompetent young patients with GIM who had good prognosis after treatment. Compared to other case reports on GIM, our cases had unusual infection sites and no obvious predisposing factors, which make it important to highlight these cases. Case presentation The first case was that of a 16-year-old immunocompetent boy who was admitted with gastrointestinal bleeding and perforation due to a gastric ulcer. Strategies used to arrest bleeding during emergency gastroscopy were unsuccessful. An adhesive mass was then discovered through laparoscopy. The patient underwent type II gastric resection. Pathological examination of the mass revealed bacterial infection and GIM. The second case was of a 33-year-old immunocompetent woman with a recent history of a lower leg sprain. The patient subsequently became critically ill and required ventilatory support. After hemodynamic stabilization and extubation, she presented with hematemesis due to exfoliation and necrosis of the stomach wall. The patient underwent total gastrectomy plus jejunostomy. The pathology results revealed severe bacterial infection and fungal infection that was confirmed as GIM. The patient fully recovered after receiving anti-infective and antifungal treatments. Conclusions Neither patient was immunosuppressed, and both patients presented with gastrointestinal bleeding. GIM was confirmed via pathological examination. GIM is not limited to immunocompromised patients, and its diagnosis mainly relies on pathological examination. Early diagnosis, timely surgical treatment, and early administration of systemic drug treatment are fundamental to improving its prognosis.

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Section: Discussionmentioning

confidence: 98%

Mucormycosis-induced upper gastrointestinal ulcer perforation in immunocompetent patients: a report of two cases

et al. 2021

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“… 2 Unlike other fungal opportunist infections affecting patients with compromised immunity, cancer, or recipients of organ transplant, mucormycosis can occur in patients with diabetes mellitus, 2 , 3 , 4 renal insufficiency, alcoholism, 5 , 6 , 7 or even with an intact immunity system. 8 , 9 , 10 These underlying conditions not only predispose to the disease but also worsen the outcome of patients. Our first patient had diabetes and renal insufficiency as risk factors of mucormycosis.…”

Section: Discussionmentioning

confidence: 99%

“…Zygomycosis was first described as a cause of human disease in 1885 2 . Unlike other fungal opportunist infections affecting patients with compromised immunity, cancer, or recipients of organ transplant, mucormycosis can occur in patients with diabetes mellitus, 2–4 renal insufficiency, alcoholism, 5–7 or even with an intact immunity system 8–10 . These underlying conditions not only predispose to the disease but also worsen the outcome of patients.…”

Section: Discussionmentioning

confidence: 99%

Fatal invasive gastric mucormycosis: Two case reports

Khsiba

Moalla

Nechi³

et al. 2022

Clinical Case Reports

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Mucormycosis is a fungal infection affecting most commonly immunocompromised patients. Hereby, we report two cases: the first one is about a 61‐year‐old female with diabetes who presented with vomiting. The upper gastrointestinal endoscopy showed a budding grayish process which corresponded to an invasive mucormycosis in histology. As laboratory tests showed renal dysfunction, conventional amphotericin B was started at low doses since liposomal form was unavailable in Tunisia. Evolution was marked by a worsening of renal function leading to drug therapy withdrawal. Total gastrectomy was delayed because of a pulmonary embolism and was practiced 2 months later. The patient passed away 10 days after surgery. The second patient was a 59‐year‐old man who presented with vomiting and fast worsening of general state. At admission, he had a septic shock. Explorations revealed an invasive gastric mucormycosis. He died few days after admission. Thus, prompt diagnosis of mucormycosis and rapid initiation of treatment based on amphotericin B and surgical debridement is necessary to improve prognosis.

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“…The diagnosis is nearly always made by biopsy of the suspected area during or after surgery or endoscopy, or at autopsy [1,2,5,9,10]. Treatment of mucormycosis involves a combination of antifungal therapy with surgical debridement of infected and necrotic tissues [4][5][6]10]. Additionally, early identification and treatment of an underlying predisposing factors, such as diabetes mellitus, immunosuppressive drugs, and neutropenia, chronic alcoholism, and HIV infection is vital to successfully treat invasive mucormycosis [5,8,11].…”

Section: Discussionmentioning

confidence: 99%

“…While any organ system may be affected, rhino-orbital-cerebral and pulmonary infections dominate the literature [3][4][5]. Very few cases of gastrointestinal mucormycosis in an immunocompetent host have been reported [5,6]. The aim of this case report is to highlight the importance of early detection and aggressive medical management of invasive mucormycosis may result in good outcome.…”

Section: Introductionmentioning

confidence: 95%

Invasive intestinal mucormycosis in a 40-year old immunocompetent patient - a rarely reported clinical phenomenon: a case report

Wotiye

Ayele

2020

BMC Gastroenterol

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Background: Mucormycosis is rare, life-threatening fungal infection. Frequently observed in those patients having underlying immunosuppression such as, diabetes, organ transplantation, Human immunodeficiency virus (HIV) infection, and elevated serum iron. However, invasive intestinal mucormycosis occurring in immunocompetent individuals without the traditional risk factors is extremely rare clinical phenomenon. Case presentation: We report a 40-year-old male patient who presented with 1 week history of diffuse abdominal pain and high grade fever, associated with vomiting and frequent loose stools. Has history of chronic alcohol ingestion. Otherwise, no past history of chronic medical illness, nor he had contact with individuals with similar illness. He was in a septic shock with multiple organ failure up on presentation to emergency room. Physical examination revealed icterus sclera with abdominal tenderness. He was immediately resuscitated using crystalloids, supported with inotrope, and antibiotics. Histopathological examination of tissue sample from colonic ulcer biopsy revealed invasive intestinal mucormycosis. Patient showed full clinical and histopathological resolution after course of parenteral Liposomal Amphotercin B. Conclusion: This case highlights the fact that, despite its life-threatening nature, it's possible to treat patients with invasive intestinal mucormycosis with aggressive antifungal and supportive care without surgical intervention, provided that all the necessary supportive care were initiated early and the disease was diagnosed early and appropriate medical management was initiated timely. In addition, it's important to consider intestinal mucormycosis even in patients who are immunocompetent without traditional risk factors.

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A rare case of gastric mucormycosis in an immunocompetent patient

Cited by 10 publications

References 5 publications

Mucormycosis-induced upper gastrointestinal ulcer perforation in immunocompetent patients: a report of two cases

Mucormycosis-induced upper gastrointestinal ulcer perforation in immunocompetent patients: a report of two cases

Fatal invasive gastric mucormycosis: Two case reports

Invasive intestinal mucormycosis in a 40-year old immunocompetent patient - a rarely reported clinical phenomenon: a case report

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