An unusual cause of massive upper gastrointestinal bleeding-gastric mucormycosis

Abstract

Mucormycosis of the gastrointestinal tract is a life threatening infection most commonly seen in patients with severe immunosuppression. A 42-year-old male with history of choriocarcinoma was admitted to the intensive care unit with septic shock. He developed massive hematemesis requiring upper endoscopy which showed multiple deep gastric ulcers. Due to uncontrollable bleeding he underwent an emergent gastrectomy which revealed necrotic ulcers with evidence of angioinvasion in the ulcer bed with mucor organisms. The PCR revealed the mucor to be Mycotypha microspora which is extremely rare. We discuss the challenges involved in the diagnosis and treatment of gastric mucormycosis.

Figure 1:

Upper gastrointestinal endoscopy revealing multiple deep ulcers in the body (yellow arrows) with fresh blood in the lumen of the stomach.

Figure 2:

Gross examination of gastrectomy specimen revealing multiple deep ulcers with necrotic base (yellow arrow).

Figure 3:

Hematoxylin and eosin staining at ×400 magnification showing a broad aseptate fungus with variable angle branching (yellow arrows) consistent with mucormycosis in a background of cell debris.

Figure 4:

Broad aseptate fungus (green arrow) consistent with mucormycosis surrounding and invading into ghost outline of blood vessel (yellow arrow) consistent with angioinvasion. Grocott’s methenamine silver stain (GMC stain) at ×400 magnification.