RESUMO
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.
Assuntos
Adulto , Feminino , Humanos , Acidentes de Trânsito , Anfotericina B , Endoscopia do Sistema Digestório , Fungos , Gastrectomia , Traumatismos Cardíacos , Ruptura Cardíaca , Hemorragia , Hospitalização , Hifas , Melena , Mucorales , Mucormicose , Traumatismo Múltiplo , Úlcera GástricaRESUMO
Mucormycosis is a rare, severe infection with fungi of the order Mucorales. It is usually found in immunocompromised patients with diabetic ketoacidosis, glucocorticosteroid use, neutropenia in the setting of malignancy, and burns. Rhinocerebral disease is the most common form of mucormycosis. Other major symptoms are pulmonary, cutaneous, gastrointestinal, and systemic dissemination. Successful treatment requires removal of the underlying risk factor, antifungal therapy with amphotericin B, and aggressive surgery. We present a case of gastric perforation due to mucormycosis with diabetic ketoacidosis and chronic pancreatitis, with a review of the literature.
Assuntos
Humanos , Anfotericina B , Queimaduras , Cetoacidose Diabética , Fungos , Hospedeiro Imunocomprometido , Mucorales , Mucormicose , Neutropenia , Pancreatite Crônica , Fatores de RiscoRESUMO
Mucormycosis is a rare, fulminating, opportunistic fungal infection that occurs almost exclusively in immunocompromised hosts such as patients with diabetes, leukemia, lymphoma. These fungi are ubiquitous in nature, and can be found on decaying vegetation and in the soil. So they are relatively frequent contaminants in the clinical microbiology laboratory. Recently the incidence of mucormycosis is rising associated with the increasing use of immunosuppressive agents, antibiotics. Though mucormycosis is frequently fatal, there has been a significant improvement in the outcome by early diagnosis and aggressive treatment. Mucormycosis can be categorized as rhinocerebral, pulmonary, gastrointestinal, cutaneous, widely disseminated and miscellaneous; gastro-intestinal involvement is extremely rare. We report a patient with gastric mucormycosis who had diabetes mellitus and alcoholic hepatitis. His chief complaint was an epigastric pain, and the gastroscopy showed huge multiple ulcers, coated with exudates. The histologic examination revealed multiple broad, nonseptate hyphae with right angle branchings, diagnosed as mucormycosis.
Assuntos
Humanos , Alcoólicos , Antibacterianos , Diabetes Mellitus , Diagnóstico Precoce , Exsudatos e Transudatos , Fungos , Gastroscopia , Hepatite Alcoólica , Hifas , Hospedeiro Imunocomprometido , Imunossupressores , Incidência , Leucemia , Linfoma , Mucormicose , Solo , ÚlceraRESUMO
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.