Angioinvasive gastrointestinal mucormycosis with duodenal necrosis and perforation in a patient with visceral myopathy

Abstract

A 55-year-old woman with a past medical history of visceral myopathy with multiple resultant abdominal surgeries, colectomy caused by severe pseudo-obstruction, and end-stage renal disease on hemodialysis presented with complaints of nausea, abdominal distention, vomiting, and diarrhea for five days. Small-bowel obstruction was identified on CT. She subsequently developed acute gastrointestinal bleeding, anemia, and hemodynamic instability. Extensive gastric ulceration with frank hemorrhage prompted urgent subtotal gastrectomy with multiple intraoperative findings, including a necrotic distal duodenum. Surgical pathology showed invasive fungal infection of the duodenum with perforation, morphologically compatible with invasive mucormycosis. The patient was started on intravenous liposomal amphotericin B, but despite best efforts, the patient ultimately succumbed to this invasive fungal infection in addition to sepsis and multi-organ failure.

Zusammenfassung

Eine 55-jährige Frau mit einer vorbekannten viszeralen Myopathie und mehreren daraus resultierenden abdominalen Operationen, darunter eine Kolektomie aufgrund einer schweren Pseudoobstruktion, sowie dialysepflichtiger Niereninsuffizienz stellte sich mit seit 5 Tagen bestehenden Beschwerden über Übelkeit, abdominelle Schmerzen, Erbrechen und Durchfall vor. Im CT wurde ein Dünndarmverschluss festgestellt. Im Verlauf entwickelte sie eine akute gastrointestinale Blutung. Eine Gastroskopie zeigte eine ausgedehnte Magenulzeration mit offener Blutung, welche eine subtotale Gastrektomie zur Folge hatte. Intraoperativ wurde ein nekrotisches distales Duodenum festgestellt. Die chirurgische Pathologie ergab eine invasive Pilzinfektion des Duodenums mit Perforation, die morphologisch mit einer invasiven Mukormykose vereinbar war. Die Patientin wurde mit intravenösem liposomalem Amphotericin B behandelt, aber trotz aller Bemühungen erlag die Patientin schließlich dieser invasiven Pilzinfektion.

Keywords

mucormycosis - enteric visceral myopathy - mucorales

Schlüsselwörter

Mucormykose - viszerale Enteropathie - Mucorales

Publication History

Received: 01 January 2023

Article published online:
12 April 2023

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