Invasive Gastric Mucormycosis-a Case Report

Mucormycosis is an opportunistic fungal infection that is associated with high mortality in immunocompromised individuals. While rhinocerebral and pulmonary forms are most common, primary gastrointestinal mucormycosis is very uncommon. The stomach is the most commonly affected organ followed by the colon and ileum in alimentary zygomycosis. We report a rare case of invasive gastric mucormycosis in a 50-year-old diabetic gentleman with a history of chronic alcoholism presenting with complaints of pain and distension of the abdomen for 6 days associated with fever, nausea, vomiting and anorexia. At presentation, he was hemodynamically unstable, febrile with uncontrolled blood sugar level and had negative HIV serology. There was generalized guarding, rigidity and distension of the abdomen and investigations confirmed perforative peritonitis. Upon exploration, there was solitary large 4x4 cm size perforated ulcer in the gastric body with greenish, greyish sloughed out mucosa within. Wedge resection of the ulcer with primary closure was performed. Histopathology revealed aseptate, broad, obtuse angled fungal hyphae, and invasive mucormycosis was confirmed by special stains like Periodic acid-Schiff (PAS) and Gomori's methenamine silver (GMS). Very few cases of invasive gastric mucormycosis associated with uncontrolled diabetes and alcoholism have been reported in the literature. Delayed presentation of the patient along with rapid progression to fungal septicaemia resulted in the case fatality despite early surgical intervention and critical care management.