Gastric Ulcer and Perforation due to Mucormycosis in an Immunocompetent Patient

Abstract

Mucormycosis is a rare and life-threatening fungal infection that is associated with high mortality in immunocompromised individuals. Although it most commonly affects lungs and paranasal sinuses, cases of invasive mucormycosis of the gastrointestinal tract have also been reported. Gastrointestinal mucormycosis (GIM) is most commonly found in the stomach, colon, and ileum. Etiologies of GIM include ingestion of spores and penetrating abdominal trauma, causing mucocutaneous disruption. We present a case of an immunocompetent man who presented to our hospital after a gunshot wound to the abdomen. His hospital course was complicated with the development of invasive GIM in the form of a large gastric ulcer, which caused gastrointestinal bleeding and eventually perforation.

Fatal invasive gastric mucormycosis: Two case reports

“… 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.…”

“…The mode of transmission of mucormycosis involves inhalation or ingestion of spores and direct inoculation into damaged mucocutaneous surfaces. 9 …”

“… 2 , 10 Factors predisposing for gastrointestinal mucormycosis (GIM) include malnutrition, typhoid fever, uremia, and penetrating trauma. 9 , 12…”

“…The confirmation of diagnosis is based on anatomopathological examination of tissue samples showing fungal hyphae. 9 , 14 …”

“… 11 A delay in treatment greater than 6 days worsens the prognosis and seems to double the mortality rates. 9 The cornerstone of drug therapy is amphotericin B which constitutes the first line treatment at a daily dose of 1 to 1.5 mg/kg for a duration of 4–6 weeks. 5 , 9 , 16 The liposomal form is preferred for its lower risk of nephrotoxicity and the possibility to administrate higher doses: 5 to 10 mg/kg/day.…”