Gastric Mucormycosis Followed by Traumatic Cardiac Rupture in an Immunocompetent Patient

Sang Won Lee; Hyun Seok Lee

doi:10.4166/kjg.2016.68.2.99

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Lee and Lee: Gastric Mucormycosis Followed by Traumatic Cardiac Rupture in an Immunocompetent Patient

Case Report

Korean J Gastroenterol 2016;68(2):99-103.

Published online: 4 October 2016

DOI: https://doi.org/10.4166/kjg.2016.68.2.99

Gastric Mucormycosis Followed by Traumatic Cardiac Rupture in an Immunocompetent Patient

Sang Won Lee, Hyun Seok Lee

Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea

Correspondence to: Hyun Seok Lee, Department of Internal Medicine, Kyungpook National University Medical Center, 807 Hoguk-ro, Buk-gu, Daegu 41404, Korea. Tel: +82-53-200-2603, Fax: +82-53-200-2027, E-mail: lhsworld@nate.com

Received 12 April 2016 Revised 22 June 2016 Accepted 29 June 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Gastric mucormycosis is a rare and life-threatening fungal disease, caused by fungus in the order Mucorales. While rhino-cerebral and pulmonary forms are common, gastric mucormycosis is an uncommon site for the disease. We diagnosed gastric mucormycosis in a 41-year-old female who had severe multiple trauma, including cardiac rupture, due to a traffic accident. Eighteen days after hospitalization, she passed 800 mL of melena over one day. We performed upper esophagogastroduodenoscopy (EGD) and found a huge gastric ulcer with bleeding. Histopathological examination identified non-septated and right-angled branching fungal hyphae, and we diagnosed gastric mucormycosis. We recommended total gastrectomy to her but she refused the operation, so she was treated with liposomal amphotericin B for 53 days. After two months of treatment with liposomal amphotericin B, we again performed EGD and found a healed gastric ulcer. After four months, with another EGD, we found that the gastric mucormycosis was completely healed.

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Keywords: Gastric mucormycosis, Immunocompetent, Heart rupture, Amphotericin B

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Fig. 1.

Abdominal CT finding. Irregular gastric wall thickening and air-bubble formation at gastric wall (arrow) were seen. Both pleural effusions were also found.

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Fig. 2.

Endoscopic findings after melena episode. Huge gastric ulcer with bleeding at great curvature side of gastric body and fundus, covered with yellowish exudate.

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Fig. 3.

Histopathologic findings shown as multiple broad-based, non-septated, right-angle branched fungal hyphae (arrow) with tissue infiltration in H&E (A, ×200), periodic acid-schiff stain (B, ×200), and Gomori methenamine silver stain (C, ×200).

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Fig. 4.

Endoscopic findings four weeks after starting amphotericin B treatment, showing improving gastric ulcer with surrounding regenerating mucosa at cardia and proximal body.

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Fig. 5.

Endoscopic finding 16 weeks after starting amphotericin B treatment. Gastric ulcer scar formation without rugal fold formation was seen at proximal body.

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