A Case of Gastric Mucormycosis in a 21-Year-Old Patient With Hemophagocytic Lymphohistiocytosis

Abstract

Mucormycosis is an angioinvasive, opportunistic infection. Diabetes Mellitus and immunosuppression are the most common risk factors for fungal infection. Without prompt treatment, the infection can be fatal. A 21-year-old male patient presented with gastritis-like symptoms refractory to proton pump inhibitor (PPI) therapy. He recently received treatment for Hemophagocytic Lymphohistiocytosis (HLH), confirmed by bone marrow biopsy and fungal sinusitis. Esophagogastroduodenoscopy (EGD) revealed extensive gastric involvement by Mucormycosis. The patient was given antifungal drugs and a resection of necrotic stomach tissue. Gastric mucormycosis is a rare presentation of the angioinvasive fungus. The patient's young age and lack of distinguishing risk factors such as diabetes or immunosuppression are also unusual. Furthermore, the patient's unique presentation with gastric mucormycosis compounded by a recent diagnosis of Hemophagocytosis lymphohistiocytosis produces a valuable case study in management.

Keywords: functional endoscopic sinus surgery (fess); fungal rhino sinusitis; gastric biopsy; gastrointestinal mucormycosis; hemetemesis.

Figure 1. Photomicrograph showing broad aseptate fungal hyphae of Mucormycosis species of paranasal sinus mucosa. Inset showing GMS special stain highlighting the fungal elements.