A Cecal Mucormycosis Mass Mimicking Colon Cancer in a Patient with Renal Transplant: A Case Report and Literature Review

Abstract

BACKGROUND Mucormycosis is a rare, invasive, and opportunistic fungal infection that occurs in the setting of neutropenia, immune deficiency, solid-organ transplant, and iron overload. The gastrointestinal system is a rare site of mucormycosis, and gastrointestinal mucormycosis is associated with high mortality and accounts for 4-7% of all cases. CASE REPORT We present the case of a 64-year-old hypertensive man with transfusion-dependent myelodysplastic syndrome who underwent renal transplant surgery 11 years ago. He also was taking maintenance Deferasirox for iron overload. He presented with a 2-day history of right lower-quadrant abdominal pain, nausea, vomiting, and non-bloody diarrhea. An abdominal examination revealed guarding and a 5×6 cm mass in the right iliac fossa. A CT scan of the abdomen showed signs of perforation of a cecal mass. As the patient was unstable, emergency right hemicolectomy and end ileostomy were performed. After the surgery, the patient was moved to the Intensive Care Unit (ICU) and a broad-spectrum antibiotic was administered. Histopathological examination results received on postoperative day 5 showed broad pauciseptate hyphae with substantial blood-vessel infiltration, suggestive of mucormycosis. Amphotericin B was started; however, on the same day, his condition deteriorated and he was moved back to the ICU. Despite maximum cardiorespiratory support, he had multiorgan failure and died. CONCLUSIONS Gastrointestinal mucormycosis presentation is non-specific, the diagnosis is often made late or is missed, and mortality remains high. High clinical suspicion, early diagnosis, and combined antifungal and surgical treatment is the best way to reduce mortality and improve survival.

Figure 1.

Abdominal computed tomography without contrast showing marked circumferential wall thickening of the cecum with ulcerations and air along the thickened wall extending to the right lateral abdominal wall.

Figure 2.

Abdominal computed tomography without contrast showing marked circumferential wall thickening of the cecum with ulcerations and air along the thickened wall extending to the right lateral abdominal wall.

Figure 3.

Histopathological slide of the colon showing broad pauciseptate hyphae (arrow) (periodic acid-Schiff stain, 20× magnification).

Figure 4.

Histopathological slide showing evidence of thrombosis and angioinvasion (arrow) of vascular wall by the mucormycosis seen against a background of a neutrophil and macrophage in a hematoxylin and eosin stain (40× magnification).