Synchronous Small Bowel Gangrene With Pyelonephritis Secondary to Mucormycosis: A Disastrous Complication of COVID-19 Pandemic

Abstract

Mucormycosis is a rare infection caused by fungi of the order Mucorales. The infection frequently involves the rhino-cerebral or respiratory system and involvement of the gastrointestinal (GI) tract and kidney are rare. It usually infects immunocompromised individuals due to various causes and an upsurge is hypothesized to be linked with irrational use of steroids during coronavirus disease 2019 (COVID-19) pandemic. We encountered a rare case of systemic mucormycosis that involved both renal as well as mesenteric vessels and led to ischemia of both vital organs. The patient developed massive bowel gangrene involving the duodenum, proximal jejunum, and left kidney due to angioinvasive mucormycosis. The diagnosis of GI mucormycosis may further increase during the current pandemic. The physicians, as well as surgeons, should be aware of this unwanted complication and keep a high index of suspicion for this rare disease.

Keywords: angioinvasive; bowel gangrene; covid-19; gastrointestinal mucormycosis; vascular necrosis.

Figure 1. Intra-operative images.

a) Resected specimen of bulky left kidney with areas of necrosis; b) Gangrenous bowel along with thickened mesentery

Figure 2. Histopathology images.

a) Necrosis and shedding of epithelial cells of renal tubules in the presence of multiple foldable, broad aseptate fungal hyphae of mucor species; b) Mesenteric vein thrombosis and fungal hyphae in the vessel wall (arrow pointed); c) Periodic acid stain positive fungal hyphae (arrow pointed); d) Grocott’s methanamine silver positive fungal hyphae (arrow pointed).