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

Abstract

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.

Gastrointestinal Mucormycosis-Induced Massive Lower Gastrointestinal Bleeding, Rectal Perforation, and Pulmonary Embolism: A Long Diagnostic Pathway in a Case Report

“… 5–7 , 11 , 12 Many patients with mucormycosis had presented with risk factors for immunosuppression, including diabetes (9%), persistent neutropenia, hematologic malignancies (44%), HIV infection, prematurity malnutrition and undernutrition, long-term systemic corticosteroid therapy, immunosuppressive therapy following organ or stem cell transplantation, and increased serum iron levels. 1 , 2 , 4–8 , 11 , 12 Our patient had type II diabetes mellitus. The diagnosis of GI mucormycosis often remains late because of the nonspecific presentation.…”

“…The main routes of entry are the sinuses, lungs, gastrointestinal (GI) tract and skin. 1,2 The entire organ system can be affected, but rhino-orbital, cerebral and pulmonary infections dominate the literature. [1][2][3][4] The GI form of mucormycosis is by far the least frequent.…”

“…1,2 The entire organ system can be affected, but rhino-orbital, cerebral and pulmonary infections dominate the literature. [1][2][3][4] The GI form of mucormycosis is by far the least frequent. 4 These fungi are responsible for both superficial and deep tissue destruction associated with angioinvasion.…”

“…Massive GI bleeding and GI perforation are the most common cause of death. 2,5 The prognosis of GI mucormycosis is often poor due to delayed diagnosis because of its atypical manifestations requiring a long diagnostic process. 2,[4][5][6] Despite the intensive use of antifungal therapy and surgical debridement, the mortality rate of adult patients varies from 20% to 100%.…”

“…2,5 The prognosis of GI mucormycosis is often poor due to delayed diagnosis because of its atypical manifestations requiring a long diagnostic process. 2,[4][5][6] Despite the intensive use of antifungal therapy and surgical debridement, the mortality rate of adult patients varies from 20% to 100%. 2,5 We report a case of GI mucormycosis presenting as massive hematochezia, multiple gastric ulcers and rectal perforation in a 75-year-old man with type II diabetes mellitus.…”