Fatal invasive gastric mucormycosis: Two case reports

Abstract

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.

COVID-19 associated mucormycosis a recent challenge

“…The patient had to stop conventional amphotericin B due to a renal function impairment; she also underwent total gastrectomy 2 months after the diagnosis but died 10 days later. 7 The male patient presented with gastric pain, vomiting, worsened general state, and fever; the upper GI endoscopy showed a bleeding gastric ulcer, and the biopsy study detected typical zygomycetes hyphae. He did not undergo specific treatment for mucormycosis, and the outcome included septic shock and hemophagocytic syndrome, dying after eight days of admission.…”

“…The authors emphasized the association of mucormycosis with diabetic ketoacidosis. 1 Khsiba et al 7 reported fatal invasive gastric mucormycosis in a 61‐year‐old diabetic Tunisian woman and a previously healthy 59‐year‐old foreign man living in Tunisia. The woman had a one-week history of vomiting after 4 months of inhaled corticoids for cough, and the upper GI endoscopy with biopsy revealed invasive mucormycosis by Rhisopus arrhizus .…”

“…He did not undergo specific treatment for mucormycosis, and the outcome included septic shock and hemophagocytic syndrome, dying after eight days of admission. 7 The authors stressed the mortality being up to 85% without early diagnosis and therapy. 7 Noor et al 10 reported a 21-year-old man presenting gastritis-like symptoms, who was recently treated for hemophagocytic lymphohistiocytosis, and a fungal sinusitis.…”

“… 7 The authors stressed the mortality being up to 85% without early diagnosis and therapy. 7 Noor et al 10 reported a 21-year-old man presenting gastritis-like symptoms, who was recently treated for hemophagocytic lymphohistiocytosis, and a fungal sinusitis. The upper GI endoscopy revealed an extensive gastric involvement by mucormycosis, and the patient underwent antifungal drugs and resection of the necrotic gastric tissue.…”