Gastrointestinal mucormycosis causing an acute abdomen in the immunocompromised pediatric patient--three cases

Abstract

Mucormycosis is an infection caused by a ubiquitous fungus in immunocompromised individuals. Typically, it invades blood vessels, producing thrombosis and tissue infarction. This infection spans all pediatric age groups and can lead to hollow viscus perforation and bowel obstruction. A 30-month old male with large cell anaplastic lymphoma had a bowel obstruction. During emergency laparotomy, an ileoileal intussusception was identified, which required resection and anastomosis. In the pathological specimen, fungi of the Mucorales order were found to be associated with tissue necrosis. On the eighth day of life, a premature infant had abdominal distension secondary to bowel perforation. Partial gastric resection and multiple intestinal stomas were performed. Death occurred soon after, secondary to multiorgan failure. The autopsy and surgical specimens showed widespread mucormycosis. An adolescent had meningococcemia-induced septic shock. During recovery, hemorrhagic colitis developed, which led to perforation. The subtotal colectomy specimen showed widespread mucormycosis. The laparotomy findings are typical (black necrotic tissue involving the bowel), and when seen in the immunocompromised patient, should make one suspect gastrointestinal mucormycosis. Aggressive surgical debridement of devitalized tissue augmented by intravenous antifungal medication is the mainstay of treatment.