Gastrointestinal mucormycosis: report of two cases

Abstract

Abstract: 

Mucormycosis is an infection caused by Zygomycetes fungi of the Mucorales order, usually associated with high morbidity and mortality. It is considered an opportunistic mycosis, affecting mainly immunocompromised patients (prolonged use of corticosteroids, decompensated type 2 diabetes, hematological neoplasms, transplants, HIV, trauma and burns). Among the forms of presentation are rhinoorbitocerebral, pulmonary, cutaneous, disseminated and gastrointestinal, the latter being very rare. In the gastrointestinal form, the stomach is the most frequently affected site, followed by the colon and ileum, and it usually presents as gastric, appendicular, colonic or ileal masses or perforations, with possible peritonitis and sepsis, associated in some cases with massive gastrointestinal bleeding. The symptoms are not specific, which means that this pathology requires a high index of suspicion and the diagnosis is therefore generally delayed.

The objective of this presentation is to report two cases of gastrointestinal mucormycosis.

One of the cases corresponds to a patient who, after a prolonged hospitalization due to an accident, presented an acute abdomen, with multiple intestinal perforations. After a torpid course, he died without known cause of said perforations, for which an autopsy was performed.

The other patient, with a history of prolonged treatment with glucocorticoids and intercurrent COVID19 infection, presented with lower gastrointestinal bleeding and perforated acute abdomen, for which a subtotal colectomy was performed, with suspected diagnosis of Crohn's disease due to the distribution and characteristics of the lesions.

Microscopically, in both cases, ulcers and perforations were observed in which the presence of thick, asept and branched hyphae stood out, characteristics compatible with mucormycetes that were positive with PAS staining.

It is worth noting the need for a high index of suspicion and to consider this pathology as a possible differential diagnosis in view of the non-specificity of the signs and symptoms, carrying out the pertinent studies and thus arriving at a diagnosis and treatment that prevents rapid evolution of this pathology that behaves aggressively