Total Gastric Necrosis Due to Mucormycosis: A Rare Case of Gastric Perforation

Abstract

BACKGROUND Spontaneous gastric perforation is usually a complication of peptic ulcer disease, or a postoperative complication resulting from gastric torsion. Mucormycosis (or zygomycosis) is an uncommon opportunistic fungal infection that is usually seen in immunocompromised patients and is associated with significant morbidity and mortality. This report is of a rare case of spontaneous gastric perforation due to mucormycosis infection. CASE REPORT A 52-year-old woman, with a past medical history of heroin abuse, diabetes mellitus, hypertension, and chronic kidney disease treated by dialysis, presented to the emergency department with cellulitis of the arms. Following hospital admission, her medical condition deteriorated, and she developed septic shock and multiorgan failure, requiring transfer to the intensive care unit (ICU), where she was diagnosed with a perforated hollow viscus as the cause. Surgical exploration showed that the mucosa of the stomach was necrotic and perforated, but the remaining bowel appeared normal. Total gastrectomy was performed, and a jejunostomy feeding tube was inserted. Histopathology of the gastric tissue confirmed infection with mucormycosis. The patient was treated with adjunctive liposomal amphotericin B, her condition improved, and she was extubated on postoperative day 2. However, the patient died on postoperative day 21 due to sepsis and multiorgan failure. CONCLUSIONS Mucormycosis is an opportunistic angioinvasive fungal infection, and gastric perforation is a rare clinical presentation. However, knowledge of the association between gastric necrosis and perforation and mucormycosis infection might lead to early diagnosis and treatment and reduce patient morbidity and mortality.

Figure 1.

Enhanced abdominal computed tomography (CT) imaging. Enhanced abdominal computed tomography (CT) imaging shows free air and a large amount of free fluid in the abdominal cavity indicating the perforation of a hollow viscus perforation (red arrows), and gastric pneumatosis, or intramural gas in the gastric wall (blue arrows).

Figure 2.

The macroscopic appearance of the transmural gastric necrosis showing a large perforation.

Figure 3.

Photomicrograph of the histological appearance of mucormycosis. A gastric wall tissue section examined by light microscopy. The histology of the fungal form of mucormycosis shows large, non-septate hyphae with 90-degree angle hyphal branching and the property of angioinvasion that results in tissue necrosis.

Figure 4.

Photomicrographs showing the morphology of mucormycosis. Grocott-Gömöri methenamine silver stain (GMS) (black).