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Addasi Y, Nguyen AH, Sabri A, Ahmad F, Rangray R, Velagapudi M. Gastrointestinal Mucormycosis: A Clinical Review. Gastroenterology Res 2023; 16:249-253. [PMID: 37937225 PMCID: PMC10627358 DOI: 10.14740/gr1662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/02/2023] [Indexed: 11/09/2023] Open
Abstract
Mucormycosis is a devastating fungal infection that is usually seen in immunocompromised hosts. It is caused by fungi of the subphylum Mucoromycotina, order Mucorales, with most cases caused by Mucor, Rhizopus, or Rhizomucor species. It can involve any organ system and can disseminate in severe cases. Lately, there has been an increased number of reports for mucormycosis infection in immunocompetent patients. Gastrointestinal system involvement is rare compared to other organ systems but has been increasingly reported in the literature. Mucormycosis can affect any part of the gastrointestinal tract and lead to different presentations depending on the area of involvement. Due to the paucity of the condition, there has been no specific guidelines on how to treat gastrointestinal mucormycosis. In this review, we discuss the risk factors of gastrointestinal mucormycosis, clinical presentation, approach to diagnosis, and most recent treatment modalities for gastrointestinal mucormycosis.
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Affiliation(s)
- Yazan Addasi
- Department of Internal Medicine, CHI Health Creighton University Medical Center, Omaha, NE, USA
| | | | - Ahmed Sabri
- Department of Pathology, CHI Health Creighton University Medical Center, Omaha, NE, USA
| | - Faran Ahmad
- Department of Infectious Diseases, CHI Health Creighton University Medical Center, Omaha, NE, USA
| | - Rajani Rangray
- Division of Gastroenterology, CHI Health Creighton University Medical Center, Omaha, NE, USA
| | - Manasa Velagapudi
- Department of Infectious Diseases, CHI Health Creighton University Medical Center, Omaha, NE, USA
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Petrovic I, Sremac M, Grbavac D, Pavlek G, Bogut A, Bakula B, Romic R, Romic I. Intramural Stomach Gas with Hepatic Portal Venous Gas Indicating Spontaneous Stomach Necrosis. Middle East J Dig Dis 2021; 13:370-373. [PMID: 36606015 PMCID: PMC9489449 DOI: 10.34172/mejdd.2021.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 01/02/2021] [Indexed: 01/07/2023] Open
Abstract
Intramural gas in the stomach associated with hepatic portal venous gas is a rare entity, which suggests ischemic or infectious pathology of the stomach. We report a case of a 73-year-old man who presented with epigastric pain and nausea of 6 hours duration followed by hematemesis. The patient had pale skin, anemia, and a diffusively tender and distended abdomen. Abdominal radiography and computed tomography (CT) revealed gas in thickened gastric wall and gas in intrahepatic portal vein branches. Surgery was indicated, which consisted of partial gastrectomy with Roux en esophago-jejunal anastomosis. Postoperative course was uneventful, and pathohistological analysis indicated stomach wall necrosis with emphysametous gastritis (EG). The patient was free of symptoms at 2 years follow-up. Intramural gas in the stomach should always be meticulously investigated to differentiate between emphysematous gastritis and gastric emphysema, as this would direct the therapeutic approach to be adopted.
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Affiliation(s)
- Igor Petrovic
- University Hospital Centre Zagreb, Department of Surgery, Croatia
| | - Maja Sremac
- University Hospital Centre Zagreb, Department of Gastroenterology, Croatia
| | - Dario Grbavac
- University Hospital Centre Zagreb, Department of Surgery, Croatia
| | - Goran Pavlek
- University Hospital Centre Zagreb, Department of Surgery, Croatia
| | - Ante Bogut
- University Hospital Sveti Duh, Department of Surgery, Croatia
| | - Branko Bakula
- University Hospital Sveti Duh, Department of Surgery, Croatia
| | | | - Ivan Romic
- University Hospital Centre Zagreb, Department of Surgery, Croatia
,Corresponding Author: Ivan Romic, MD Address : University Hospital Centre Zagreb, Kispaticeva 4, Croatia Tel : + 385238-8888 Fax : + 3851-238-8888 Email :
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Rai A, Gajula B, Kumar N, Malik A. Gastric Perforation Secondary to Fungal Gastritis in an Immuno-Competent Adult. Cureus 2021; 13:e13156. [PMID: 33692925 PMCID: PMC7937405 DOI: 10.7759/cureus.13156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Gastrointestinal (GI) tract perforation is a surgical emergency. The epidemiology and etiology of perforation vary considerably across geography. Lower GI tract perforations in the elderly predominate in the West compared to upper GI perforations in the younger population in the tropics. Fungi and viruses have been reported to cause GI perforations in immuno-compromised individuals but it is rare in immuno-competent individuals. We report a very rare case of gastric perforation secondary to fungal gastritis in an immuno-competent 35-year-old female who presented with features of peritonitis. At emergency laparotomy, gastric perforation was found which was repaired by the Cellan-Jones method. Perforation edge biopsy findings were consistent with fungal etiology. She responded well to Antifungal therapy. We conclude that fungal etiology can be considered in patients with gastric perforation without any history of peptic ulcer disease (PUD) or use of oral non-steroidal anti-inflammatory drugs.
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Affiliation(s)
- Ankit Rai
- General Surgery, All India Institute of Medical Sciences Rishikesh, Rishikesh, IND
| | - Bhargav Gajula
- General Surgery, All India Institute of Medical Sciences Rishikesh, Rishikesh, IND
| | - Navin Kumar
- General Surgery, All India Institute of Medical Sciences Rishikesh, Rishikesh, IND
| | - Akanksha Malik
- Pathology, National Institute of Pathology, New Delhi, IND.,Pathology, All India Institute of Medical Sciences Rishikesh, Rishikesh, IND
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Gastric Mucormycosis: An Infection of Fungal Invasion into the Gastric Mucosa in Immunocompromised Patients. Case Rep Gastrointest Med 2020; 2020:8876125. [PMID: 33014480 PMCID: PMC7516694 DOI: 10.1155/2020/8876125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 01/28/2023] Open
Abstract
Primary gastric mucormycosis is a rare but potentially lethal fungal infection due to the invasion of Mucorales into the gastric mucosa. It may result in high mortality due to increased risk of complications in immunocompromised patients. Common predisposing risk factors to develop gastric mucormycosis are prolonged uncontrolled diabetes mellitus with or without diabetic ketoacidosis (DKA), solid organ or stem cell transplantation, underlying hematologic malignancy, and major trauma. Abdominal pain, hematemesis, and melena are common presenting symptoms. The diagnosis of gastric mucormycosis can be overlooked due to the rarity of the disease. A high index of suspicion is required for early diagnosis and management of the disease, particularly in immunocompromised patients. Radiological imaging findings are nonspecific to establish the diagnosis, and gastric biopsy is essential for histological confirmation of mucormycosis. Prompt treatment with antifungal therapy is the mainstay of treatment with surgical resection reserved in cases of extensive disease burden or clinical deterioration. We presented a case of acute gastric mucormycosis involving the body of stomach in a patient with poorly controlled diabetes and chronic renal disease, admitted with acute onset of abdominal pain. Complete resolution of lesion was noted with 16 weeks of medical treatment with intravenous amphotericin B and posaconazole.
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Li C, Zhu H, Tan Y, Liu D. Gastrointestinal bleeding due to duodenal mucormycosis in an immunocompetent host mimicking malignancy. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2019; 111:961-962. [PMID: 31617363 DOI: 10.17235/reed.2019.6462/2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Mucormycosis is a rare and fatal infection, largely confined to immunocompromised hosts. Duodenal involvement is extremely rare. We report a case of a 67-year-old female presented with hematemesis eventually diagnosed with duodenal mucormycosis, while radiology characteristics suggested malignancy.
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Affiliation(s)
- Chen Li
- Gastroenterology, The Second Xiangya Hospital of Central South University
| | - Hongyi Zhu
- Gastroenterology, The Second Xiangya Hospital of Central South University
| | - Yuyong Tan
- Gastroenterology, The Second Xiangya Hospital of Central South University, China
| | - Deliang Liu
- Gastroenterology, The Second Xiangya Hospital of Central South University
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Termos S, Othman F, Alali M, Al Bader BMS, Alkhadher T, Hassanaiah WF, Taqi A, Sapkal A. Total Gastric Necrosis Due to Mucormycosis: A Rare Case of Gastric Perforation. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:527-533. [PMID: 29724988 PMCID: PMC5956728 DOI: 10.12659/ajcr.908952] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Female, 52 Final Diagnosis: Gastric mucormycosis Symptoms: Sepsis • surgical abdomen Medication: Liposomal amphotericine b Clinical Procedure: Total gastrectomy Specialty: Surgery
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Affiliation(s)
- Salah Termos
- Department of Surgery, Al-Amiri Hospital, Kuwait City, Kuwait
| | - Feras Othman
- Department of Surgery, Al-Amiri Hospital, Kuwait City, Kuwait
| | - Mohammad Alali
- Department of Surgery, Al-Amiri Hospital, Kuwait City, Kuwait
| | | | - Talal Alkhadher
- Department of Surgery, Al-Amiri Hospital, Kuwait City, Kuwait
| | | | - Ali Taqi
- Department of Surgery, Al-Amiri Hospital, Kuwait City, Kuwait
| | - Abhijit Sapkal
- Department of Pathology, Al-Amiri Hospital, Kuwait City, Kuwait
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