Intestinal Zygomycosis due to Absidia Corymbifera Mimicking Necrotizing Enterocolitis in a Preterm Neonate

Abstract

Zygomycosis is a rare fungal disease that occurs in compromised human hosts, including the preterm infant. The three clinical forms of zygomycosis are cellulitis, disseminated, and gastrointestinal, and the last often mimics necrotizing enterocolitis (NEC), complicating the diagnosis. This report details a case of primary gastrointestinal zygomycosis due to Absidia corymbifera, mimicking NEC, in a preterm infant, and emphasizes features that may lead to earlier diagnosis and treatment of future cases.

Novel Perspectives on Mucormycosis: Pathophysiology, Presentation, and Management

“…In particular, gastrointestinal mucormycosis has been seen in premature neonates, often in association with widespread disseminated disease (6,27,71,76,128,137). Necrotizing enterocolitis has been described largely in premature neonates (35,71,106,128,139,157,174,177) and more rarely in neutropenic adults (146,152). Rare cases of gastrointestinal mucormycosis have been described in association with other immune-compromising conditions, including AIDS (19), systemic lupus erythematosus (55), and organ transplantation (77,95,97,138).…”

Rare case of disseminated neonatal zygomycosis mimicking necrotizing enterocolitis with necrotizing fasciitis

“…In zygomycosis, cultures of affected lesions are often negative, which can delay accurate diagnosis and administration of specific treatment. No biologic or serologic diagnostic tests (eg, detection of antigens or antibody) has as yet been established, and genetic testing through polymerase chain reaction is still unavailable [1,5,7]. Consequently, the diagnosis usually depends on histopathologic examination of the surgically resected organs or the infected tissues at autopsy [2,[5][6][7]9,10].…”

“…No biologic or serologic diagnostic tests (eg, detection of antigens or antibody) has as yet been established, and genetic testing through polymerase chain reaction is still unavailable [1,5,7]. Consequently, the diagnosis usually depends on histopathologic examination of the surgically resected organs or the infected tissues at autopsy [2,[5][6][7]9,10]. Typical and characteristic histopathologic findings are as follows: (1) broad, aseptate filaments with right angle branching hyphae in tissue specimens and (2) typical hyphae showing features of perivascular and blood vessel invasion, particularly, arterial invasion, which can cause arterial thrombosis and subsequent ischemic necrotic changes in the tissue [2,[5][6][7][9][10][11].…”

“…Neonatal gastrointestinal zygomycosis usually mimics NEC clinically [5][6][7][8][9][10][11]. In zygomycosis, cultures of affected lesions are often negative, which can delay accurate diagnosis and administration of specific treatment.…”

“…Prompt diagnosis and early treatment of combining aggressive surgery and amphotericin B administration are necessary for patient survival [1][2][3]. However, antemortal diagnosis of gastrointestinal zygomycosis in the neonate is difficult, the clinical course mimics necrotizing enterocolitis (NEC) and is often diagnosed only by histopathologic examination [4][5][6][7][8][9][10]. Diagnostic delay frequently leads to a poor outcome.…”