Gastric Mucormycosis: An Infection of Fungal Invasion into the Gastric Mucosa in Immunocompromised Patients

Abstract

Primary gastric mucormycosis is a rare but potentially lethal fungal infection due to the invasion of Mucorales into the gastric mucosa. It may result in high mortality due to increased risk of complications in immunocompromised patients. Common predisposing risk factors to develop gastric mucormycosis are prolonged uncontrolled diabetes mellitus with or without diabetic ketoacidosis (DKA), solid organ or stem cell transplantation, underlying hematologic malignancy, and major trauma. Abdominal pain, hematemesis, and melena are common presenting symptoms. The diagnosis of gastric mucormycosis can be overlooked due to the rarity of the disease. A high index of suspicion is required for early diagnosis and management of the disease, particularly in immunocompromised patients. Radiological imaging findings are nonspecific to establish the diagnosis, and gastric biopsy is essential for histological confirmation of mucormycosis. Prompt treatment with antifungal therapy is the mainstay of treatment with surgical resection reserved in cases of extensive disease burden or clinical deterioration. We presented a case of acute gastric mucormycosis involving the body of stomach in a patient with poorly controlled diabetes and chronic renal disease, admitted with acute onset of abdominal pain. Complete resolution of lesion was noted with 16 weeks of medical treatment with intravenous amphotericin B and posaconazole.

Gastric mucormycosis in an immunocompetent host: A case report

“…In 2020, Haider et al reported a case of gastric mucormycosis complicated by mucosal invasion in a patient with poorly controlled diabetes and chronic renal disease, confirmed by histopathologic examination, PCR and culture of the biopsy specimens detecting Rhizopusmicrosporus DNA. 5 Chow et al reported a case of gastric angioinvasive mucormycosis in 2017, as a deadly complication in immunocompromised patient after penetrating trauma. 6 A rare case of gastric mucormycosis complicated with gastropleural fistula was reported by Tomohisa et al in a 82 years old female on immunosuppressives for adult onset Still's disease.…”

“…Newer therapies for mucormycosis include posaconazole and deferiprone and adjunctive hyperbaric oxygen therapy. 5,6…”

Pulmonary embolism and gastric bleed with disseminated mucormycosis - treading dangerous waters

“…CT of the abdomen has non-specific signs such as ulceration, mucosal thickening, or intramural mass lesion. Endoscopy usually reveals variably sized and numbered mucosal ulceration with green to black exudates with or without necrosis of the tissue [10]. Imaging of paranasal sinuses and brain shows mucosal thickening of sinuses, soft tissue density in paranasal sinuses extending into orbit and brain, brain abscess, ring-enhancing lesions, infarcts, and cavernous sinus thrombosis [11].…”

Cecum Necrosis with Terminal Ileum Perforation Due to Invasive Fungal Infection in a Patient with Diabetes Mellitus and Acute Myeloid Leukemia: A Case Report

“…The presenting symptoms of GI mucormycosis vary, and the most common one is abdominal pain. Nausea, vomiting, hematemesis, hematochezia, and melena are the other clinical manifestations of the disease (5). The mortality after GI involvement is often due to perforation, peritonitis, and GI bleeding (1).…”