Emaree Cobb, MD1, Natasha McMillan, MD2, Jiemin Zhou, MD3, Fareed Rajack, MD3; 1Howard University Hospital, Miami, FL; 2Howard University Hospital, Jamaica, NY; 3Howard University Hospital, Washington, DC
Introduction: Mucormycosis is an uncommon cause of GI infection. Bowel infarction and hemorrhagic shock can occur due to GI mucormycosis and the prognosis for patients is poor. It is typically diagnosed based on pathology not microbiology
Methods: A 68-year-old male with a history of squamous cell carcinoma of the esophagus status post chemotherapy, HTN and DMII presented for elective esophagectomy with gastric pull through. His post-op course was complicated by several episodes of bright red blood per rectum. He underwent colonoscopy demonstrating two 3cm ulcers found in the ascending colon (FIGURE 1) with raised edges and a localized area of moderately congested and erythematous mucosa found in the cecum (FIGURE 2). Pathology demonstrated aseptate fragmented fungal hyphae consistent with Mucorales (Mucormycosis)(FIGURE 3) present in the lumen of the capillaries in granulation tissue and multiple fungal forms embedded in fibro-purulent exudate in addition to ulcerated colonic mucosa with acute on chronic inflammation. He was started on a course of amphotericin B for treatment of invasive mucormycosis. Discussion: Although unusual, mucormycosis of the gastrointestinal tract may occur as the result of ingestion of spores in susceptible individuals. The stomach is the most common site followed by the colon. Rhino-orbital and pulmonary mucormycosis are acquired by the inhalation of spores. In healthy individuals, cilia transport these spores to the pharynx and they are cleared through the gastrointestinal tract. The agents of mucormycosis are angioinvasive; infarction of infected tissues is the hallmark of invasive disease. Treatment of invasive mucormycosis involves surgical debridement and antifungal therapy. IV amphotericin B is the drug of choice for initial therapy.
FIGURE 1: Ascending colon ulcer
Figure 2: Appendiceal orifice inflammation
FIGURE 3: Ribbon-like broad hyphae with no septation
Disclosures: Emaree Cobb indicated no relevant financial relationships. Natasha McMillan indicated no relevant financial relationships. Jiemin Zhou indicated no relevant financial relationships. Fareed Rajack indicated no relevant financial relationships.