Gastrointestinal Mucormycosis in the Setting of Colonic Pseudo-Obstruction

TL;DR

A 49-year-old man with diabetes developed a rare fungal infection in his gastrointestinal tract after surgery, highlighting the challenges of diagnosing and treating mucormycosis.

Contribution

This case report highlights gastrointestinal mucormycosis as an emerging disease with high mortality, emphasizing the role of surgical debridement in treatment.

Findings

The patient was diagnosed with Rhizopus microsporus after surgical intervention revealed fungal hyphae.

Gastrointestinal mucormycosis often goes undetected until post-mortem due to its high mortality rate.

Surgical debridement is critical for managing the infection, which spreads rapidly without proper control.

Abstract

Mucormycosis is a rare opportunistic infection caused by the fungi order Mucorales that can affect multiple different organ systems. A 49-year-old man with a history of poorly controlled diabetes and hypertension presented with acute-on-chronic abdominal pain with profound worsening in the past 24 hours. He was found to have chronic intestinal pseudo-obstruction, with pneumatosis of the transverse colonic wall requiring total abdominal colectomy. Within two weeks after surgery, he developed fundal gastric injury with herniation requiring primary repair with surgical laparotomy. Tissue histopathology post-procedure revealed broad and irregular fungal hyphae, revealed to be Rhizopus microsporus on broad-spectrum PCR. Gastrointestinal mucormycosis is an emerging invasive fungal disease, often diagnosed post-mortem due to high mortality rates. Risk factors include noncommunicable chronic diseases such as diabetes and malignancy, as well as communicable diseases, including COVID-19. Surgical debridement is key to improving outcomes, as infection tends to cross tissue planes without adequate source control.

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