Primary Invasive Gastric Mucormycosis Presenting as Meleney's Gangrene

Abstract

Mucormycosis is an uncommon but potentially lethal fungal infection in immunocompromised individuals. The natural history of the disease is vascular invasion followed by thrombosis and necrosis of infected tissues. It can affect any organ system. Gastrointestinal (GI) mucormycosis is quite rare. Here, we report a case of primary invasive gastric mucormycosis in a 45-year-old male with diabetes and ethanol-related chronic liver disease who presented with necrotizing fascitis of the left thigh, groin, and lower abdominal wall. At presentation, he was hemodynamically unstable, anuric, and febrile with a high blood glucose level. He was stabilized with aggressive debridement and critical care management. During hospitalization, he developed sudden episode of upper GI bleed. Gastroscopy revealed extensive ulcerations with thick mucus in the fundus and body of the stomach. Biopsy from the lesions and special stain examination was consistent with invasive gastric mucormycosis. Delayed presentation of our patient and rapid progression to fungemia resulted in mortality.