Taborda Mariane, Takahashi Juliana Possatto Fernandes, Nascimento Jessica de Brito Ferreira, Mari Julia Ferreira, Oliveira Vítor Falcão de, Magri Adriana Satie Gonçalves Kono, Nastri Ana Catharina de Seixas Santos, Magri Marcello Mihailenko Chaves
Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil.
Instituto Adolfo Lutz, Unidade de Patologia Quantitativa, São Paulo, São Paulo, Brazil.
Rev Inst Med Trop Sao Paulo. 2025 Jun 9;67:e35. doi: 10.1590/S1678-9946202567035. eCollection 2025.
Gastrointestinal mucormycosis (GIM) and leptospirosis are two severe diseases associated with high morbidity and mortality rates. The coexistence of these two conditions has not yet been reported in the literature. This study presents a case involving this rare association. A 49-year-old man from Sao Paulo, Brazil, was hospitalized with acute abdominal pain, low blood pressure, and jaundice. He had a history of contact with floodwater and ingestion of contaminated water, was hospitalized with acute abdominal pain, low blood pressure, and jaundice. Upon ICU admission, he developed jaundice, acute renal failure requiring hemodialysis, and alveolar hemorrhage necessitating intubation. Leptospirosis was confirmed by serological tests and treated with ceftriaxone for 14 days. Two weeks later, he developed severe enterorrhagia, requiring a massive transfusion and a total colectomy with terminal ileostomy. Histopathology revealed necrotizing granulomatous inflammation with hyphae indicative of mucormycosis. He was treated with amphotericin B for 7 weeks, followed by posaconazole. Abdominal CT scans over the next five months showed complete clinical and radiological improvement. The association between mucormycosis and leptospirosis has not been previously documented, highlighting the diagnostic challenges and the critical importance of early detection. Successful management in this case required timely surgical intervention combined with prolonged antifungal therapy.
胃肠道毛霉菌病（GIM）和钩端螺旋体病是两种严重疾病，发病率和死亡率都很高。这两种疾病并存的情况尚未见文献报道。本研究报告了一例涉及这种罕见关联的病例。一名来自巴西圣保罗的49岁男子因急性腹痛、低血压和黄疸入院。他有接触洪水和饮用受污染水的病史，因急性腹痛、低血压和黄疸入院。入住重症监护病房后，他出现黄疸、需要血液透析的急性肾衰竭以及需要插管的肺泡出血。血清学检测确诊为钩端螺旋体病，并用头孢曲松治疗14天。两周后，他出现严重肠出血，需要大量输血并进行全结肠切除术加末端回肠造口术。组织病理学显示坏死性肉芽肿性炎症，伴有提示毛霉菌病的菌丝。他接受了7周的两性霉素B治疗，随后使用泊沙康唑。在接下来的五个月里，腹部CT扫描显示临床和影像学完全改善。毛霉菌病和钩端螺旋体病之间的关联此前尚未有文献记载，凸显了诊断挑战以及早期检测的至关重要性。该病例的成功治疗需要及时的手术干预和长期的抗真菌治疗。
