Gastrointestinal Mucormycosis of the Jejunum in an Immunocompetent Patient

Sun, Mingshu; Hou, Xianming; Wang, Xiaoting; Chen, Ge; Zhao, Yuanhui

doi:10.1097/md.0000000000006360

Cited by 12 publications

(17 citation statements)

References 26 publications

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“…A total of 200 cases of GI mucormycosis in non‐classical immunosuppressed or apparently immunocompetent hosts reported during 1948 through 2017 in English literature . The case details could be retrieved for 176 cases.…”

Section: Resultsmentioning

confidence: 99%

Gastrointestinal mucormycosis in apparently immunocompetent hosts—A review

Kaur

Ghosh

Rudramurthy

et al. 2018

Mycoses

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The diagnosis of gastrointestinal (GI) mucormycosis is always a challenge due to its non-specific clinical presentations and often diagnosed at autopsy. Recently increased number of GI mucormycosis has been reported in immunocompetent hosts and during 1948 through 2017, 200 cases of GI mucormycosis are available in literature. We could review 176 cases where case details were available. Majority (50.6%) of the cases were reported from Asia. The disease is nearly equally recorded in adults and paediatric population. The infection commonly affected the intestine (64.2%) followed by stomach (33%). A significant improvement in antemortem diagnosis was noted since 2001. Rhizopus species were the predominant (67.5%) aetiological agents. Amphotericin B was the most commonly used drug (93.4%). Despite improvement of antemortem diagnosis and therapy, the mortality was 60.5% and 67.5% in adults and children respectively. Combined medical and surgical therapy (reported in 47.8% patients) had significantly better survival rate than those receiving either of them. Analysing the clinical presentations, we propose to suspect GI mucormycosis in a malnourished/ dehydrated child (especially premature neonate) with history of exposure to broad-spectrum antibiotics or formula/spoon feeding and presenting with mass in abdomen, abdominal distension or bilious vomiting; and an adult presenting with abdominal distension, fever or GI bleed with underlying risk factors for mucormycosis.

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Section: Resultsmentioning

confidence: 99%

Gastrointestinal mucormycosis in apparently immunocompetent hosts—A review

Kaur

Ghosh

Rudramurthy

et al. 2018

Mycoses

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“…European Confederation of Medical Mycology 2019 guideline proposes the use of Posaconazole as rst line treatment with moderate strength, especially in case of renal failure like our patient (14). Reversal of underlying problems is also fundamental to improve treatment outcome (7,8). A study by Gebremariam et.…”

Section: Discussionmentioning

confidence: 99%

“…However, prognosis among infected individuals are extremely poor, and mortality has been found to be associated with the site of infection (5). Most infected patients have underlying factors of compromised immunity, such as organ transplantation, malignancy, persistent neutropenia, poorly controlled diabetes mellitus and systemic corticosteroid therapy (7,8).…”

Section: Discussionmentioning

confidence: 99%

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Colonic Mucormycosis Causing Massive Lower Gastrointestinal Bleeding: A Case Report

Chiang

Lee

Tan

et al. 2020

Preprint

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BackgroundLower 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.Case PresentationWe 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 1500ml. Colonoscopy was done 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 two months of antifungal treatment. Follow up colonoscopy post-treatment was normal with no ulcer visualized.ConclusionsEarly 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.

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“…1,5 The jejunum is the least affected and only few cases of jejunal mucormycosis have been reported so far and none in children. 1–4…”

Section: Discussionmentioning

confidence: 99%