Bhat Vivek, S Anitha, Thomas Anu, Kanavi Jayashree V, Thomas Annamma
Obstetrics and Gynecology, St. John's Medical College, Bangalore, IND.
Cureus. 2021 Aug 25;13(8):e17428. doi: 10.7759/cureus.17428. eCollection 2021 Aug.
Mucormycosis is a rare opportunistic infection, usually seen in diabetics, immunocompromised, or those with coronavirus disease 2019 (COVID-19). Gastrointestinal involvement is uncommon but often deadly. We report a case of gastrointestinal mucormycosis causing intestinal perforation in a non-diabetic, COVID-19 negative, immunocompetent woman, associated with puerperal sepsis. A 22-year-old woman presented to our center on post-natal day five, following delivery with insertion of an intrauterine contraceptive device (IUCD). She had complaints of breathlessness, fatigue, and giddiness. Examination revealed tachycardia, tachypnea, hypotension, and bilateral pedal edema. Following appropriate investigations, she was diagnosed with puerperal sepsis with pre-renal acute kidney injury. Imaging was suggestive of retained products of conception, and she subsequently underwent dilation and evacuation (D&E) on day eight of admission. Following brief symptomatic improvement, on day 10 of admission, she developed vomiting, abdominal distension, and pain, with obstipation. Erect X-ray showed air under the diaphragm, suggestive of perforation. She emergently underwent laparotomy with limited right hemicolectomy, ileostomy with mucous fistula. Intraoperative findings revealed a closed-loop obstruction involving terminal ileum, with two perforations. The biopsy report later revealed colonization of Mucor and hemorrhagic necrosis along the entire length of the resected specimen. She was started on amphotericin B, and after a slow recovery, was discharged. Gastrointestinal mucormycosis is rare and has a mortality rate of 94%. It is usually seen in those with predisposing factors for mucormycosis. This is the first report of mucormycosis associated with puerperal sepsis. It is typically acquired via ingestion and may cause perforation, where mortality is further increased. Diagnosis can only be confirmed by histopathology demonstrating the characteristic morphology of Mucor. Treatment requires resection of necrotic tissues, intensive treatment with amphotericin B, and correction of predisposing factors. Our case highlights the need for a high degree of suspicion for mucormycosis in patients with intestinal perforation, even if immunocompetent, and its potential association with puerperal sepsis.
毛霉菌病是一种罕见的机会性感染，通常见于糖尿病患者、免疫功能低下者或2019冠状病毒病（COVID-19）患者。胃肠道受累并不常见，但往往致命。我们报告一例非糖尿病、COVID-19阴性、免疫功能正常的产妇发生胃肠道毛霉菌病并导致肠穿孔，且伴有产褥期败血症。一名22岁女性在产后第5天因分娩后放置宫内节育器（IUCD）而前来我院。她主诉呼吸急促、疲劳和头晕。检查发现心动过速、呼吸急促、低血压和双侧足部水肿。经过适当检查，她被诊断为产褥期败血症合并肾前性急性肾损伤。影像学检查提示有残留的妊娠产物，随后她在入院第8天接受了刮宫术（D&E）。经过短暂的症状改善后，在入院第10天，她出现呕吐、腹胀和疼痛，并伴有便秘。立位X线片显示膈下游离气体，提示穿孔。她紧急接受了剖腹手术，行有限的右半结肠切除术、带黏液瘘的回肠造口术。术中发现末端回肠存在闭袢性梗阻，有两个穿孔。活检报告后来显示切除标本的整个长度均有毛霉菌定植和出血性坏死。她开始接受两性霉素B治疗，经过缓慢恢复后出院。胃肠道毛霉菌病很罕见，死亡率为94%。它通常见于有毛霉菌病易感因素的人群。这是第一例与产褥期败血症相关的毛霉菌病报告。它通常通过摄入感染，可能导致穿孔，此时死亡率会进一步升高。只有通过组织病理学显示毛霉菌的特征形态才能确诊。治疗需要切除坏死组织，用两性霉素B进行强化治疗，并纠正易感因素。我们的病例强调，即使是免疫功能正常的患者，对于肠穿孔患者也需要高度怀疑毛霉菌病，以及它与产褥期败血症的潜在关联。
