A Case of Gastric Mucormycosis Associated with Diabetes Mellitus and Uremia / 대한소화기내시경학회지

Mucormycosis is an infection caused by fungi of the class Zygomycetes, order Mucorales. These are usual ubiquitous saprophytes but occasionally cause opportunistic infection in immunocompromised patients. Typically, these fungi invade blood vessels, and produce thrombosis and tissue infarction, so causing host fatality. These infections can be categorized into rhinocerebral, pulmonary, widely disseminated, gastrointestinal, cutaneous and miscellaneous form. Most of mucormycosis cases reported in Korea were rhinocerebral form except for three cases, which were gastrointestinal mucormycosis, accompanied with hematologic malignancy or immunosuppressing treatment. We experienced a 58-year-old male with gastric mucormycosis, who had diabetes and mild uremia without hematologic malignancy and immunosuppressive treatments. His chief complaints were abdominal pain and melena, and gastroscopy showed a 3 3 cm irregular edged ulcer considering malignancy. Its histological findings showed large, thin-walled, non-septate and right-angled branching fungal hyphae in necrotic tissue, diagnosed as mucormycosis. Finally he was dead due to severe hematemesis.

Establishment of an Helicobacter pylori-Eradication Regimen in Consideration of Drug Resistance , Recrudescence and Reinfection Rate of H . pylori / 대한내과학회지

OBJECTIVE: This study was conducted to establish an ideal treatment regimen for H. pylori eradication in three aspects: clinical, microbiological, and reinfection. METHODS: Four hundred thirty two patients with H. pylori positive peptic ulcer were randomized to receive two types of triple therapy: one includes colloidal bismuth subcitrate, metronidazole and tetracycline (BMT), and the other includes omeprazole, amoxicillin and clarithromycin (OAC). RESULTS: More than 50% of symptom reduction within 1 week was 94.4% both in OAC and in BMT group. The percentages of side effects were 21.6% and 27.1% in OAC and BMT regimen, respectively. Good compliance with at least 85% intake was 99.0% and 95.2% in OAC and BMT regimen. The eradication rates of H. pylori were 85.9% and 89.1% in OAC and BMT regimen. Resistance rates to metronidazole and clarithromycin were 40.6% and 10.2% by E test, 74.3% and 27.0% by broth microdilution, and 45.3% and 10.9% by disk diffusion method. The eradication rates for H. pylori was 100% and 77.8% by BMT in patients with metronidazole-sensitive and -resistant strains, and 100% and 80.0% by OAC with clarithromycin- sensitive and -resistant strains, without significance by their resistances. The recrudescence rate within 1 year after eradication was 21.2% and 14.2% for OAC and BMT regimen without significant difference. The reinfection rate after 1 year was 4.0% and 5.0% for OAC and BMT regimen. CONCLUSION: Because the eradication rate of BMT regimen is 89.1% in spite of high metronidazole resistance rate, and there was no statistical difference in the aspects of symptom reduction, side effect, compliance, recrudescence and reinfection rate, BMT regimen is as favorable as OAC to eradicate H. pylori.