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Case Reports
. 2020 Nov;53(6):746-749.
doi: 10.5946/ce.2020.180. Epub 2020 Nov 19.

Rare and Fatal Gastrointestinal Mucormycosis (Zygomycosis) in a COVID-19 Patient: A Case Report

Epifanio Silvino do Monte Junior  1 , Marcos Eduardo Lera Dos Santos  1 , Igor Braga Ribeiro  1 , Gustavo de Oliveira Luz  1 , Elisa Ryoka Baba  1 , Bruno Salomão Hirsch  1 , Mateus Pereira Funari  1 , Eduardo Guimarães Hourneaux de Moura  1
Affiliations
Case Reports

Rare and Fatal Gastrointestinal Mucormycosis (Zygomycosis) in a COVID-19 Patient: A Case Report

Epifanio Silvino do Monte Junior et al. Clin Endosc. 2020 Nov.

Abstract

The novel coronavirus disease (COVID-19) quickly spread to all continents. However, data regarding all the signs and symptoms of COVID-19 are insufficient. Patients with COVID-19 might present higher susceptibility to fungal coinfections. Mucormycosis is a rare and often life-threatening fungal disease characterized by vascular invasion by hyphae, resulting in thrombosis and necrosis. This is the first case report of mucormycosis in a COVID-19 patient. An 86-year-old male patient was admitted to the emergency room with acute diarrhea, cough, dyspnea, and fever from 5 days prior. Blood tests revealed a hemoglobin level of 14.3 mg/dL. Five days following the admission, the patient presented with melena and a hemoglobin level of 5.6 mg/dL. A transfusion of three units of red blood cells was required. Esophagogastroduodenoscopy revealed two giant gastric ulcers with necrotic debris and a deep hemorrhagic base without active bleeding. Furthermore, biopsies confirmed mucormycosis. Despite intensive care, the patient died 36 hours after the esophagogastroduodenoscopy.

Keywords: Coronavirus infections; Gastroenteritis; Gastrointestinal hemorrhage; Mucormycosis; Zygomycosis.

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Conflict of interest statement

Conflicts of Interest: Eduardo Guimarães Hourneaux de Moura reports personal fees from Boston Scientific and Olympus outside the submitted work. The other authors have no financial conflicts of interest.

Figures

Fig. 1.
Fig. 1.
The chest computed tomography revealed ground-glass opacity with consolidative abnormalities.
Fig. 2.
Fig. 2.
The esophagogastroduodenoscopy demonstrated a giant ulcer in (A) the greater curvature, (B) fundus, and (C) antrum.
Fig. 3.
Fig. 3.
(A) The gastric border and base with necrotic fibrinoid debris. The fungus structures are visible at a low-power view (arrows). Hematoxylin and eosin staining, original magnification ×100. (B) Presence of broad, irregular, non-septate hyphae of mucormycosis (arrows). Hematoxylin and eosin staining, original magnification ×400. (C) Hyphae stained with periodic acid-Schiff stain (arrow), original magnification ×400. (D) Note the hyphae with typical 90-degree angle branching (arrow). Grocott’s methenamine staining, original magnification ×400.
See this image and copyright information in PMC

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