Ileocolonic mucormycosis in adult immunocompromised patients: A surgeon’s perspective

Intestinal mucormycosis as a differential diagnosis of small bowel ischemia

Intestinal mucormycosis is a rare manifestation of the Mucor fungus, associated with high mortality and typically found in immunocompromised patients, though it has also been described in immunocompetent individuals. The mode of acquisition is digestive. It usually presents as abdominal pain, with ischemia and intestinal perforation, and the diagnosis is often histopathological after surgical resection. We present the case of a 54-year-old female patient with recurrent acute myeloid leukemia undergoing treatment with daunorubicin-cytarabine and experiencing febrile neutropenia. She developed patchy and progressive intestinal ischemia that evolved into intestinal necrosis, which was treated with antifungal medications and surgery. Examination of the surgical specimen revealed aseptate wide hyphae with branching at right angles, suggestive of Mucor fungus. This is a rare but highly mortal pathology in which clinical, radiological, and surgical suspicion is essential for early diagnosis and treatment, thus improving the patient's prognosis.

Fatal invasive gastric mucormycosis: Two case reports

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.

A Fatal Case of Disseminated Intestinal Mucormycosis in a Patient with Vibrio Sepsis

Mucormycosis is a fungal infection that primarily causes opportunistic infections. Gastrointestinal mucormycosis is a rare infection that can occur in immunocompromised patients, nevertheless, prompt diagnosis and treatment is essential because it can be fatal. Gastrointestinal mucormycosis can only be diagnosed based on the findings of a pathological examination. Mucormycosis should be included in the differential diagnosis if the condition of patients with underlying immunocompromised conditions or diseases does not improve with general intensive care.

A Rare Presentation of Ileocecal Mucormycosis in a Heart Transplant Recipient

Mucorales is an order of angioinvasive fungi that classically infects immunocompromised patients. As an aerogenous pathogen, it most frequently causes disease of the lungs and paranasal sinuses. Gastrointestinal mucormycosis represents a particularly rare site of infection. This case report describes the complicated presentation of ileocecal mucormycosis in an immunocompromised orthotopic heart transplant recipient. The diagnosis was made status-post ileocolonic resection, and the patient was promptly started on liposomal amphotericin B and micafungin. Unfortunately, the patient ultimately succumbed to disseminated infection. In this study, we review the epidemiology, the presenting features of gastrointestinal mucormycosis, and emphasize the prompt initiation of therapy on suspected disease.

Co-infection of intestinal tuberculosis and mucormycosis in a patient with Down syndrome: a unique case report with literature review

Mucormycosis represents several unusual opportunistic infection caused by saprophytic aseptate fungi. There is a recent rise in cases of mucormycosis due to an increase in diabetic and immunodeficient patients like patients on long-term steroids, immunomodulators due to organ transplantation, malignancies, mainly haematological malignancies, and autoimmunity. Anatomically, mucormycosis can be localised most commonly as rhino-orbito-cerebral followed by pulmonary, disseminated, cutaneous and gastrointestinal, rarest being small intestinal. Patients with Down syndrome are immunodeficient due to their impaired immune response. Disseminated tuberculosis is also common in immunodeficient patients. We report a rare case of small intestinal mucormycosis in a patient with Down syndrome with coexisting intestinal tuberculosis. Due to the invasiveness of mucormycosis, the patient succumbed to death despite providing aggressive surgical debridement and medical management.

Mucormycosis causing massive lower gastrointestinal bleeding: a case report

BACKGROUND

Lower gastrointestinal bleeding (LGIB) is very common in the hospital setting. Most bleedings stop spontaneously, but rare infectious causes of LGIB may lead to rapid and serious complications if left untreated and are sometimes very difficult to diagnose preoperatively.

CASE PRESENTATION

We described a young man with poorly controlled Type I diabetes mellitus and chronic alcohol abuse who presented with acute altered mental status. During his hospitalization for treatment of diabetic ketoacidosis, acute renal failure, and sepsis, he suddenly developed massive hematochezia of 1500 mL. Colonoscopy was performed and a deep ulcer covered with mucus with peripheral elevation was noted at the transverse colon. Biopsy of the ulcer later revealed nonpigmented, wide (5-20 µm in diameter), thin-walled, ribbon-like hyphae with few septations and right-angle branching suggestive of mucormycosis demonstrated by Periodic acid-Schiff stain. He received 2 months of antifungal treatment. Follow up colonoscopy post-treatment was normal with no ulcer visualized.

CONCLUSIONS

Early diagnosis and treatment of gastrointestinal (GI) mucormycosis infection is critical but can be challenging, especially in the setting of massive hematochezia. Therefore, clinical awareness for immunocompromised patients and prompt antifungal prophylaxis in cases with high suspicion of infection are essential.

CT appearance of gastrointestinal tract mucormycosis

Mucormycosis is a fungal infection caused by fungi of order mucorales. It is most commonly seen in patients with an impaired immune system due to any cause. Gastrointestinal mucormycosis is the least frequent type and may be a primary disease or a feature of generalized mucormycosis. Angioinvasion is the hallmark feature of mucormycosis, leading to bowel infarction which is the responsible for the most common clinical complaint of pain, and is also responsible for most of the imaging findings in this disease. The stomach is most commonly involved organ in the gastrointestinal tract and pneumatosis and lack of gastric wall enhancement are the most common imaging findings. Areas of bowel wall thickening and/ or lack of enhancement are seen in small bowel mucor and perforation can occur due to ischemia. Colonic mucor can present with mural thickening, or complete lack of definition or 'disappearance' of bowel wall with associated air containing collections. Mucormycosis affecting the bowel has a high mortality rate and early recognition and intervention may improve patient outcomes significantly. It should be suspected in immunosuppressed patients with imaging findings of unexplained bowel ischemia, infarction and/or pneumatosis without any obvious visible vascular thrombus.

Mucormycosis-induced ileocecal perforation: A case report and review of literature

Gastrointestinal mucormycosis is a rare form of invasive mucormycosis with high fatality rate due to difficulty in establishing its diagnosis. The classic risk-factors include immunosuppression and metabolic derangement. A case of ileocecal mucormycosis following intracardiac repair of congenital heart disease in a 17-year-old boy is described here who lacked the typical risk-factors for mucormycosis. Ileocecal mucormycosis affecting an individual without the classic risk-factors is uncommon.

A Cecal Mucormycosis Mass Mimicking Colon Cancer in a Patient with Renal Transplant: A Case Report and Literature Review

Patient: Male, 64-year-old

Final Diagnosis: Cecal mucormycosis

Symptoms: Abdominal pain • diarhea • nausea • vomiting

Medication: —

Clinical Procedure: Ileostomy placement • right hemicolectomy

Specialty: Surgery

An unusual cause of bowel obstruction: Rhizopus Arrhizus diverticulitis

Mucormycosis is a fungal infection primarily afflicting immunocompromised or diabetic patients. Its presentation ranges from rhino-orbito-cerebral infections to disseminated mucormycosis with angioinvasion. We present a patient who developed a bowel obstruction one month after bone marrow transplant and was diagnosed with Rhizopus arrhizus diverticulitis despite antifungal therapy since transplantation. She underwent surgical removal with immediate fungal resurgence, declined further invasive intervention and was discharged on palliative isavuconazole. Seven months later she is alive with fungal containment.

Gastric Ulcer and Perforation due to Mucormycosis in an Immunocompetent Patient

Mucormycosis is a rare and life-threatening fungal infection that is associated with high mortality in immunocompromised individuals. Although it most commonly affects lungs and paranasal sinuses, cases of invasive mucormycosis of the gastrointestinal tract have also been reported. Gastrointestinal mucormycosis (GIM) is most commonly found in the stomach, colon, and ileum. Etiologies of GIM include ingestion of spores and penetrating abdominal trauma, causing mucocutaneous disruption. We present a case of an immunocompetent man who presented to our hospital after a gunshot wound to the abdomen. His hospital course was complicated with the development of invasive GIM in the form of a large gastric ulcer, which caused gastrointestinal bleeding and eventually perforation.

Neutropenic Enterocolitis due to Mucormycosis in a Patient with Myelodysplastic Syndrome

Neutropenic enterocolitis is a fatal enterocolitis occurring in neutropenic patients with immunocompromised diseases including hematologic malignancies. Gastrointestinal (GI) mucormycosis in hematologic malignancies has been rarely reported. Especially, in myelodysplastic syndrome (MDS), GI mucormycosis has never been reported. We report a case of GI mucormocysis manifesting as neutropenic enterocolitis in a patient with MDS.

Successful treatment of gastrointestinal mucormycosis in an adult with acute leukemia: case report and literature review

Mucormycosis has emerged as an important cause of invasive fungal infection in patients with hematologic malignancies. Gastrointestinal mucormycosis is an unusual presentation of this invasive fungal infection, and it causes considerable morbidity and mortality. Such outcomes are due in part to a nonspecific presentation that results in delays in diagnosis and treatment. Successful treatment of gastrointestinal mucormycosis involves surgical debridement and appropriate antifungal therapy.

Gastrointestinal mucormycosis after abdominal aortic aneurysm repair and prolonged hospitalization: A case report and review of the literature

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Mucormycosis is an opportunistic fungal infection which can sometimes affect the gastrointestinal tract.

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Infection causes thrombosis and necrosis of affected tissue and carries a high mortality rate.

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A high index of suspicion is necessary to diagnose and begin treatment with amphotericin B.

Introduction

Mucormycosis is a rare fungal infection typically affecting immunocompromised hosts. One form of the disease affects the gastrointestinal tract.

Presentation of case

We present the case of a 70-year old patient with no recognized risk factors that developed gastrointestinal mucormycosis after urgent abdominal aortic aneurysm repair.

Discussion

There are several risk factors for this infection, such as hematological malignancies, solid organ or stem cell transplants and diabetes. The infectious agent causes thrombosis and necrosis of involved tissues and organs and carries a high mortality rate.

Conclusion

Mucormycosis is an opportunistic infection which can sometimes affect the gastrointestinal tract. A high index of suspicion is necessary in order to make an early diagnosis and promptly start an appropriate treatment regimen.

Gastrointestinal mucormycosis in immunocompromised hosts

Invasive mucormycosis is a rare fungal infection in immunocompromised hosts, but it carries a high mortality rate. Primary gastrointestinal disease is the least frequent form of presentation. Early diagnosis and treatment are critical in the management; however, symptoms are typically non-specific in gastrointestinal disease, leading to delayed therapy. To describe the clinical presentation, diagnosis, treatment and outcomes of gastrointestinal mucormycosis in immunocompromised hosts, we reviewed all cases of primary gastrointestinal mucormycosis in immunocompromised hosts reported in English literature as well as in our Institution from January 1st 1991 to December 31st 2013 for a total of 31 patients. About 52% of patients underwent solid organ transplant (SOT), while the rest had an underlying haematologic malignancy. Abdominal pain was the most common presenting symptom, followed by gastrointestinal bleeding and fever. Gastric disease was more common in SOT, whereas those with haematologic malignancy presented with intestinal disease (P = 0.002). Although gastrointestinal mucormycosis remains an uncommon condition in immunocompromised hosts, it carries significant morbidity and mortality, particularly in cases with intestinal involvement. A high index of suspicion is of utmost importance to institute early and appropriate therapy and improve outcomes.

"An unusual presentation of colonic mucormycosis mimicking carcinoma colon- a surgeon's perspective"

INTRODUCTION

Mucormycosis caused by order mucorales, an ubiquitous saprophytic mold found in soil and organic matter worldwide, is a rare but invasive opportunistic fungal infection. Gastrointestinal mucormycosis is the most uncommon clinical presentation being particularly rare, accounted for 4-7% of all cases.

PRESENTATION OF CASE

We report an unusual presentation of mucormycosis of ascending colon that was simulating carcinoma colon.

DISCUSSION

GI mucormycosis most commonly involves the stomach (57.5%), followed by the colon (32.3%) and the ileum (6.9%). Initial presentations may be abdominal pain and distension, fever, and diarrhoea. Colonic mucormycosis presenting as a mass with altered bowel habit, melena and abdominal pain in our case is extremely difficult to differentiate it from carcinoma colon. A definitive diagnosis of mucormycosis is almost always ascertained by histopathological evidence of fungal invasion of tissue.

CONCLUSION

Knowing these unusual presentations of this disease, surgeon need to maintain a high index of suspicion and perform timely and appropriate diagnostic evaluation to improve patient outcome. Prompt diagnosis, reversal of predisposing conditions, and aggressive surgical debridement remain cornerstones of therapy for this deadly disease.

Gastrointestinal mucormycosis requiring surgery in adults with hematologic malignant tumors: literature review

BACKGROUND

Gastrointestinal mucormycosis is associated with high mortality rates. Appropriate and early antifungal therapy and prompt surgical intervention are essential.

METHOD

Case report and literature review.

RESULTS

Nineteen case reports were reviewed describing adults with hematologic malignant tumors who developed intestinal mucormycosis and underwent surgery. The overall survival rate was 50%.

CONCLUSION

Intestinal mucormycosis is an infection associated with a high mortality rate although adults with underlying hematologic malignant have improved outcomes compared with other groups.

Mucormycosis of pouch of douglas in a diabetic woman

Mucormycosis is a severe fungal infection which is rare in clinical practice. This infection is usually acquired by inhalation; other portals of entry are ingestion and traumatic implantation, especially in immuno-compromised patients. Here, we present a case of mucormycosis in a 44-year-old diabetic woman. The patient had collection of fluid in the Pouch of Douglas (POD) and history of bleeding per vagina. Hysterectomy was done which showed a blackish serosal surface of the posterior uterus. Subsequent investigations revealed mycormycosis caused by Rhizopus oryzae (R. arrhizus) affecting the POD. Patient was treated with liposomal amphotericin B and is now keeping well.

A Rare Cause of Massive Upper Gastrointestinal Hemorrhage in Immunocompromised Host

Mucormycosis is an invasive and aggressive opportunistic fungal infection that usually presents with rhinocerebral or pulmonary involvement and rarely involves the gastrointestinal tract. The disease is acute with mortality rate up to 100%. A 68-year-old male was undergoing treatment at a local hospital for COPD exacerbation with IV steroids and antibiotics. Two weeks into his treatment he suddenly developed massive upper GI bleeding and hemodynamic instability that necessitated transfer to our tertiary care hospital for further treatment and management. An urgent upper endoscopy revealed multiple large and deep gastric and duodenal bulb ulcers with stigmata of recent bleeding. The ulcers were treated endoscopically. Biopsies showed fibrinopurulent debris with fungal organisms. Stains highlighted slightly irregular hyphae with rare septa and yeast suspicious for Candida. The patient was subsequently placed on fluconazole. Unfortunately, the patient’s general condition continued to worsen and he developed multiorgan failure and died. Autopsy revealed disseminated systemic mucormycosis. Most of the cases of gastrointestinal mucormycosis were reported from the tropics and few were reported in the United States. The disease occurs most frequently in immunocompromised individuals. The rare incidence of GI involvement, acute nature, severity and the problematic identification of the organisms on biopsies make antemortem diagnosis challenging. Treatment includes parenteral antifungals and debridement of the infected tissues. Gastroenterologists should be aware of this rare cause of gastrointestinal bleeding and understand the importance of communication with the reviewing pathologist so that appropriate, and often lifesaving, therapies can be administered in a timely manner.

Ileocolic mucormycosis - an unusual cause of a mass in the right iliac fossa

Mucormycosis is a relatively uncommon, aggressive and lethal mycosis. Fungi from the order Mucorales are the etiological agents of mucormycosis. The condition is more common among the immunocompromised, diabetic patients with ketoacidosis and people with iron overload syndromes. Diagnosis of mucormycosis requires a high index of suspicion regarding the possibility of the condition in high-risk individuals. Timely diagnosis is critical to survival and minimization of morbidity. A favourable outcome is possible only if appropriate treatment is initiated as early as possible. The present article reports a case of ileocolic mucormycosis involving a patient with chronic renal failure and familial hyperuricemia.

Mucormycosis: its contemporary face and management strategies

Several countries have seen rising frequencies of mucormycosis among patients with haematological disorders, malignancies, or diabetes mellitus, and among transplant recipients. Growing numbers of immunocompromised hosts, widespread use of antifungal agents inactive against mucormycosis, or other unidentified factors, could be contributing to this situation. The predominant clinical manifestations of mucormycosis vary from host to host. Additionally, risk factors specific to different subgroups have been identified, such as leukaemia, allogeneic haemopoietic stem-cell transplant, voriconazole prophylaxis, diabetes, and malnutrition. We summarise the current state of knowledge of characteristics and risk factors and discuss topical developments in therapeutic methods and strategies in the management of mucormycosis.

Intestinal mucormycosis in a neonate: A case report and review

Mucormycosis is a fungal disease that may rarely invade the gastrointestinal tract of newborn, resulting in high morbidity and mortality. Clinically, it may be indistinguishable from the neonatal necrotizing enterocolitis and the diagnosis is usually made on autopsy or histopathology of excised surgical specimen. We report a neonatal survivor of the illness.