Bowel infarction due to intestinal mucormycosis in an immunocompetent patient

Abstract

Mucormycosis is a fatal opportunistic fungal infection that typically occurs in immunocompromised patients. The classical manifestation of mucormycosis is a rhinocerebral infection, and although primary gastrointestinal infection is uncommon, it has an extremely high mortality rate in immunocompromised patients. Furthermore, cases of gastrointestinal mucormycosis in an immunocompetent host are rarely reported. Here, we describe our experience of a male patient, with no underlying disease, who succumbed to a bowel infarction caused by intestinal mucormycosis during mechanical ventilatory care for severe pneumonia and septic shock.

Keywords: Bowel; Immunocompetence; Infarction; Mucormycosis.

Fig. 1

(A) Initial chest radiograph showing haziness in both lungs, especially in right lower lung field. (B) Chest radiograph taken after 7 days in intensive care unit (ICU) showing reduced haziness. (C, D) Abdominal and pelvic computed tomography images after 12 days in ICU showing lack of colon wall enhancement and fluid collection.

Fig. 2

(A-C) Microscopic findings of resected colon. Microscopic findings of colon showing transmural infarction. Invasive fungal hyphae were observed in all layers of colon wall, especially in arterial wall (center). Fungal invasion of arterial wall was accompanied by arterial thrombosis (A: H&E, ×100; B: H&E, ×200; C: H&E, ×400). (D) Gomori's methenamine-silver stain of artery showing thick walls, noncircular cross-section, and nonseptated hyphae (×400).