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Case Reports
. 2020 Sep 16:2020:8876125.
doi: 10.1155/2020/8876125. eCollection 2020.

Gastric Mucormycosis: An Infection of Fungal Invasion into the Gastric Mucosa in Immunocompromised Patients

Haider A Naqvi  1   2   3   4 , Muhammad Nadeem Yousaf  1   2   3   4 , Fizah S Chaudhary  1   2   3   4 , Lawrence Mills  5
Affiliations
Case Reports

Gastric Mucormycosis: An Infection of Fungal Invasion into the Gastric Mucosa in Immunocompromised Patients

Haider A Naqvi et al. Case Rep Gastrointest Med. .

Abstract

Primary gastric mucormycosis is a rare but potentially lethal fungal infection due to the invasion of Mucorales into the gastric mucosa. It may result in high mortality due to increased risk of complications in immunocompromised patients. Common predisposing risk factors to develop gastric mucormycosis are prolonged uncontrolled diabetes mellitus with or without diabetic ketoacidosis (DKA), solid organ or stem cell transplantation, underlying hematologic malignancy, and major trauma. Abdominal pain, hematemesis, and melena are common presenting symptoms. The diagnosis of gastric mucormycosis can be overlooked due to the rarity of the disease. A high index of suspicion is required for early diagnosis and management of the disease, particularly in immunocompromised patients. Radiological imaging findings are nonspecific to establish the diagnosis, and gastric biopsy is essential for histological confirmation of mucormycosis. Prompt treatment with antifungal therapy is the mainstay of treatment with surgical resection reserved in cases of extensive disease burden or clinical deterioration. We presented a case of acute gastric mucormycosis involving the body of stomach in a patient with poorly controlled diabetes and chronic renal disease, admitted with acute onset of abdominal pain. Complete resolution of lesion was noted with 16 weeks of medical treatment with intravenous amphotericin B and posaconazole.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
CT scan of the abdomen displaying the transmural thickening of the stomach (white blocked arrow) and the perigastric inflammation with reactive adenopathy (white arrow).
Figure 2
Figure 2
Upper endoscopy showing ulcerated lesion in the gastric fundus with the overlaying bleeding and exudative material.
Figure 3
Figure 3
Histological examination of lesion showing polymorphonuclear neutrophils indicating inflammation of gastric mucosa (a) and fragments of invading fungal hyphae (b).
Figure 4
Figure 4
Repeat EGD showing cleared infection and ulceration in the fundus of the stomach.
See this image and copyright information in PMC

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