# Intra-abdominal Mucormycosis in an Immunocompetent Host: A Rare Presentation and Literature Review

## TL;DR

This paper reports a rare case of intra-abdominal mucormycosis in an otherwise healthy woman, highlighting the challenges in diagnosis and the high mortality risk.

## Contribution

The study presents a rare clinical case of mucormycosis in an immunocompetent individual and emphasizes the need for early diagnosis.

## Key findings

- Mucormycosis can occur in immunocompetent individuals, though it is rare.
- Delayed diagnosis and treatment are associated with high mortality in mucormycosis cases.
- Non-specific symptoms and imaging findings can complicate mucormycosis diagnosis.

## Abstract

Mucormycosis is a severe, opportunistic infection caused by Mucorales, a taxonomical group of thermotolerant fungi primarily affecting the immunocompromised. Intra-abdominal involvement in mucormycosis is a rare entity, particularly in immunocompetent individuals. We present a fatal case of gallbladder and renal mucormycosis in an immunocompetent female, leading to septic shock and death. The diagnosis was confirmed via histopathology following cholecystectomy for suspected gangrenous cholecystitis and open right nephrectomy due to kidney infarction. Quantitative polymerase chain reaction of the tissue identified the presence of Apophysomyces ossiformis. The clinical picture was confounded by ongoing sepsis due to a Klebsiella pneumoniae-infected retroperitoneal hematoma, non-specific imaging findings, and the absence of traditional risk factors for mucormycosis, leading to a delayed diagnosis. Despite surgical debridement, initiation of liposomal amphotericin B with posaconazole, and aggressive treatment in the intensive care unit, the patient succumbed to complications of mucormycosis. Despite adequate antibiotic coverage, this case underscores the importance of considering Mucorales infection in otherwise immunocompetent patients with a deteriorating clinical condition. Early diagnosis and appropriate intervention are essential in enhancing mucormycosis survivability, though mortality rates remain high in severe cases.