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Case Reports
. 2022 Sep 12;10(9):e6330.
doi: 10.1002/ccr3.6330. eCollection 2022 Sep.

Fatal invasive gastric mucormycosis: Two case reports

Amal Khsiba  1 , Manel Moalla  1 , Salwa Nechi  2 , Amina Bani  2 , Aicha Elloumi  3 , Sana Jemal  3 , Mohamed Moussaddek Azouz  1 , Mouna Medhioub  1 , Lamine Hamzaoui  1
Affiliations
Case Reports

Fatal invasive gastric mucormycosis: Two case reports

Amal Khsiba et al. Clin Case Rep. .

Abstract

Mucormycosis is a fungal infection affecting most commonly immunocompromised patients. Hereby, we report two cases: the first one is about a 61-year-old female with diabetes who presented with vomiting. The upper gastrointestinal endoscopy showed a budding grayish process which corresponded to an invasive mucormycosis in histology. As laboratory tests showed renal dysfunction, conventional amphotericin B was started at low doses since liposomal form was unavailable in Tunisia. Evolution was marked by a worsening of renal function leading to drug therapy withdrawal. Total gastrectomy was delayed because of a pulmonary embolism and was practiced 2 months later. The patient passed away 10 days after surgery. The second patient was a 59-year-old man who presented with vomiting and fast worsening of general state. At admission, he had a septic shock. Explorations revealed an invasive gastric mucormycosis. He died few days after admission. Thus, prompt diagnosis of mucormycosis and rapid initiation of treatment based on amphotericin B and surgical debridement is necessary to improve prognosis.

Keywords: diabetes; fungal infection; gastric; mucormycosis.

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Conflict of interest statement

We have no conflict of interest to declare.

Figures

FIGURE 1
FIGURE 1
Upper gastrointestinal endoscopy showing budding and infiltrating grayish process.
FIGURE 2
FIGURE 2
(A, B) Necrotic and inflammatory material comprising mycelial filaments suggesting mucormycosis.
FIGURE 3
FIGURE 3
(A) Microscopic exam in lactophenol showing large, irregular, and non‐septate hyphae. (B) Microscopic exam after culture showing the rhizoids and the columella specific for the species Rhizopus arrhizus.
FIGURE 4
FIGURE 4
CT scan of abdomen showing fundic mucosal thickening
FIGURE 5
FIGURE 5
Resected stomach showing 2 ulcers in the fundus.
FIGURE 6
FIGURE 6
Endoscopy showing fragile mucosa and a gastric ulcer with bleeding stigmata.
FIGURE 7
FIGURE 7
(A) Typical broad zygomycetes hyphae branching at right angle (PAS, 400×). (B) Zygomycetes hyphae within the gastric mucosa.
See this image and copyright information in PMC

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