Naqvi Haider A, Nadeem Yousaf Muhammad, Chaudhary Fizah S, Mills Lawrence
Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD 21218, USA.
Department of Medicine, MedStar Good Samaritan Hospital, Baltimore, MD 21239, USA.
Case Rep Gastrointest Med. 2020 Sep 16;2020:8876125. doi: 10.1155/2020/8876125. eCollection 2020.
Primary gastric mucormycosis is a rare but potentially lethal fungal infection due to the invasion of Mucorales into the gastric mucosa. It may result in high mortality due to increased risk of complications in immunocompromised patients. Common predisposing risk factors to develop gastric mucormycosis are prolonged uncontrolled diabetes mellitus with or without diabetic ketoacidosis (DKA), solid organ or stem cell transplantation, underlying hematologic malignancy, and major trauma. Abdominal pain, hematemesis, and melena are common presenting symptoms. The diagnosis of gastric mucormycosis can be overlooked due to the rarity of the disease. A high index of suspicion is required for early diagnosis and management of the disease, particularly in immunocompromised patients. Radiological imaging findings are nonspecific to establish the diagnosis, and gastric biopsy is essential for histological confirmation of mucormycosis. Prompt treatment with antifungal therapy is the mainstay of treatment with surgical resection reserved in cases of extensive disease burden or clinical deterioration. We presented a case of acute gastric mucormycosis involving the body of stomach in a patient with poorly controlled diabetes and chronic renal disease, admitted with acute onset of abdominal pain. Complete resolution of lesion was noted with 16 weeks of medical treatment with intravenous amphotericin B and posaconazole.
原发性胃毛霉病是一种罕见但可能致命的真菌感染,由毛霉目真菌侵入胃黏膜所致。由于免疫功能低下患者并发症风险增加,其可能导致高死亡率。发生胃毛霉病的常见易感危险因素包括伴有或不伴有糖尿病酮症酸中毒(DKA)的长期未控制的糖尿病、实体器官或干细胞移植、潜在的血液系统恶性肿瘤以及重大创伤。腹痛、呕血和黑便是常见的临床表现。由于该病罕见,胃毛霉病的诊断可能被忽视。对于该病的早期诊断和管理,尤其是免疫功能低下患者,需要高度怀疑指数。放射影像学检查结果对确诊无特异性,胃活检对于组织学确诊毛霉病至关重要。抗真菌治疗的及时应用是主要治疗手段,对于疾病负担广泛或临床病情恶化的病例则保留手术切除治疗。我们报告了一例急性胃毛霉病累及胃体的病例,患者患有控制不佳的糖尿病和慢性肾病,因突发腹痛入院。经静脉注射两性霉素B和泊沙康唑治疗16周后,病变完全消退。