J Korean Soc Transplant.  2018 Dec;32(4):104-107. 10.4285/jkstn.2018.32.4.104.

Successful Treatment of Invasive Gastric Mucormycosis in a Kidney Transplant Recipient

• Kim HN
• Han SA
• Park HY
• Kim HW
• Hong R
• Choi NG
• Shin MH
• Yoon NR
• Kim HL
• Chung JH
• Shin BC

• KMID: 2430590
• DOI: http://doi.org/10.4285/jkstn.2018.32.4.104

Abstract

Mucormycosis is an extremely rare but potentially life-threatening fungal infection. Gastrointestinal (GI) mucormycosis is very rare and occurs primarily in highly malnourished patients, especially in infants and children. A 55-year-old man with end-stage renal disease due to diabetic nephropathy, who had undergone deceased donor kidney transplantation 2 years prior, complained of abdominal pain and distension with a 3-day duration. Computed tomography revealed diffuse gastric wall thickening, and a huge amount of grey colored necrotic debris surrounded by erythematous erosive mucosa was observed at the antrum to upper body by GI endoscopy. The microscopic examination obtained from a GI endoscopic specimen demonstrated peptic detritus with numerous non-septate mucor hyphae in the mucosa and submucosa. Mucormycosis was diagnosed based on the clinical findings and morphological features. A total gastrectomy was performed and an antifungal agent was administered. A microscopic examination of the surgical specimen demonstrated invasive mucormycosis with numerous fungal hyphae with invasion into the mucosa to subserosa. The patient and graft were treated successfully by total gastrectomy and antifungal therapy.

Keyword

Mucormycosis; Kidney transplantation; Stomach

MeSH Terms

Abdominal Pain
Child
Diabetic Nephropathies
Endoscopy
Gastrectomy
Humans
Hyphae
Infant
Kidney Failure, Chronic
Kidney Transplantation
Kidney*
Middle Aged
Mucor
Mucormycosis*
Mucous Membrane
Stomach
Tissue Donors
Transplant Recipients*
Transplants

Figure

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  Fig. 1. Gastrointestinal endoscopy showed a huge amount of grey colored elevated necrotic debris surrounded by erythematous erosive mucosa from antrum to upper body (arrows).

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  Fig. 2. (A) Gross specimen of stomach. The black arrow indicates a perforation lesion. (B) Multifocal transluminal ulcer finding of stomach. (C) Necrotizing vasculitis finding of filled thrombi and vascular wall destruction. (D) Fungal ball (arrows). (E, F) PAS stain (E, ×400) and Gomori's Methenamine silver stain (F, ×400) sections showing broad, non-septated hyphae with right angled branches (B: HE stain, ×200; C, D: HE stain, ×400).

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