Spontaneous Gastric Necrosis: A Rare Presentation of Invasive Mucormycosis in an Immunocompetent Adult

Abstract

Spontaneous gastric perforations are usually seen in patients with untreated peptic ulcer disease. Mucormycosis, an uncommon, opportunistic, life-threatening fungal infection, rarely causes gastric perforation in immunocompetent adults. Here, we present a case of young female who was admitted to hospital for acute pain abdomen and distension with 5 days history of fever. She was operated and was found to have multiple perforations in the stomach with transmural necrosis. Despite adequate surgical excision and intravenous amphotericin B, patient succumbed to sequelae of infection.

Gastrointestinal Mucormycosis: A Clinical Review

“…For two of the three stomach mucormycosis case reports, there was evidence of hematemesis, which is one of the more common symptoms of an upper gastrointestinal bleed in these patients [ 11 , 12 ]. In the other case, there were reports of acute onset of severe abdominal pain and progressive distension with failure to pass feces or flatulence [ 13 ]. With intestinal mucormycosis, all patients have been reported to experience either low- or high-grade fever with abdominal pain [ 6 , 9 , 14 , 15 ].…”

Gastric mucormycosis

“…It can present an array of nonspecific symptoms, including discomfort, diarrhea, fever, gastrointestinal bleeding, necrosis, perforation, and as a necrotizing enterocolitis in premature neonates. 5 The mechanism of GI tract involvement in mucormycosis is unclear. Pre-existing peptic ulcer disease, consumption of food and water contaminated with Mucorales, and use of contaminated nasogastric tubes, tongue depressors, and wooden spatula are a few factors responsible for the involvement of the GI system in mucormycosis.…”

“…Pre-existing peptic ulcer disease, consumption of food and water contaminated with Mucorales, and use of contaminated nasogastric tubes, tongue depressors, and wooden spatula are a few factors responsible for the involvement of the GI system in mucormycosis. 5 , 6 Mortality rate of GI mucormycosis is reported as 40 to 78%. 4 , 5 Perforation of necrotic ulcers and peritonitis are the leading causes of death in such cases.…”

“… 5 , 6 Mortality rate of GI mucormycosis is reported as 40 to 78%. 4 , 5 Perforation of necrotic ulcers and peritonitis are the leading causes of death in such cases.…”