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Abstract
Mucormycosis is an extremely rare but potentially life-threatening fungal infection. Mucormycosis of the gastrointestinal tract manifests with features similar to ischemic colitis. A 48-year-old man with end-stage renal disease due to diabetic nephropathy underwent deceased donor kidney transplantation. He complained of abdominal pain and distension on postoperative day 17. A computed tomography (CT) scan revealed symmetrical wall thickening of the ascending colon, which was consistent with ischemic colitis. However, a follow-up CT scan showed a localized wall-off colon perforation in the hepatic flexure and segmental mural gas in the ascending colon. Microscopic examination obtained from a surgical specimen demonstrated numerous fungal hyphae and spores in the mucosa and submucosa. A total colectomy was performed, but the patient died 36 days later due to multiple organ failure, despite antifungal agents. Clinicians should be informed about fungal infection, such as colonic mucormycosis mimicking ischemic colitis, in kidney transplant patients with diabetes mellitus, and treatment should be initiated at the earliest.
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Fig. 1.
Abdominopelvic computed tomography scan. Ascites and (A) mild to (B) moderate symmetrical wall thickening (arrows) was observed on the ascending colon.
Fig. 2.
Follow-up abdominopelvic computed tomography scan revealed (A) localized wall-off colon perforation in the hepatic flexure (hollow arrow) and (B, C) segmental mural gas in the ascending colon (arrows) and (D) symmetrical wall thickening (arrow) was observed in the descending colon.
Fig. 3.
Gross photograph of the total colectomy specimen showed necrotizing colitis from the distal transverse colon to the descending colon.
Fig. 4.
Colon pathologic findings. (A) Numerous fungal hyphae and spores are noted in the mucosa and submucosa (arrows) (HE stain, ×200). (B, C, D) Fungal organisms are characterized by large non-septated hyphae with acute angle branching (B: HE stain, ×400; C: PAS, ×400; D: Gomori methenamine silver, ×400).
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