Clin Endosc.  2020 Nov;53(6):746-749. 10.5946/ce.2020.180.

Rare and Fatal Gastrointestinal Mucormycosis (Zygomycosis) in a COVID-19 Patient: A Case Report

Affiliations
  • 1Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil

Abstract

The novel coronavirus disease (COVID-19) quickly spread to all continents. However, data regarding all the signs and symptoms of COVID-19 are insufficient. Patients with COVID-19 might present higher susceptibility to fungal coinfections. Mucormycosis is a rare and often life-threatening fungal disease characterized by vascular invasion by hyphae, resulting in thrombosis and necrosis. This is the first case report of mucormycosis in a COVID-19 patient. An 86-year-old male patient was admitted to the emergency room with acute diarrhea, cough, dyspnea, and fever from 5 days prior. Blood tests revealed a hemoglobin level of 14.3 mg/dL. Five days following the admission, the patient presented with melena and a hemoglobin level of 5.6 mg/dL. A transfusion of three units of red blood cells was required. Esophagogastroduodenoscopy revealed two giant gastric ulcers with necrotic debris and a deep hemorrhagic base without active bleeding. Furthermore, biopsies confirmed mucormycosis. Despite intensive care, the patient died 36 hours after the esophagogastroduodenoscopy.

Keyword

Coronavirus infections; Gastroenteritis; Gastrointestinal hemorrhage; Mucormycosis; Zygomycosis

Figure

  • Fig. 1. The chest computed tomography revealed ground-glass opacity with consolidative abnormalities.

  • Fig. 2. The esophagogastroduodenoscopy demonstrated a giant ulcer in (A) the greater curvature, (B) fundus, and (C) antrum.

  • Fig. 3. (A) The gastric border and base with necrotic fibrinoid debris. The fungus structures are visible at a low-power view (arrows). Hematoxylin and eosin staining, original magnification ×100. (B) Presence of broad, irregular, non-septate hyphae of mucormycosis (arrows). Hematoxylin and eosin staining, original magnification ×400. (C) Hyphae stained with periodic acid-Schiff stain (arrow), original magnification ×400. (D) Note the hyphae with typical 90-degree angle branching (arrow). Grocott’s methenamine staining, original magnification ×400.


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Reference

1. Adhikari S, Gautam AR, Paudyal B, Sigdel KR, Basnyat B. Case report: gastric mucormycosis- a rare but important differential diagnosis of upper gastrointestinal bleeding in an area of Helicobacter pylori endemicity. Wellcome Open Res. 2019; 4:5.
Article
2. Kauffman CA, Malani AN. Zygomycosis: an emerging fungal infection with new options for management. Curr Infect Dis Rep. 2007; 9:435–440.
Article
3. Farmakiotis D, Kontoyiannis DP. Mucormycoses. Infect Dis Clin North Am. 2016; 30:143–163.
Article
4. Jeong W, Keighley C, Wolfe R, et al. The epidemiology and clinical manifestations of mucormycosis: a systematic review and meta-analysis of case reports. Clin Microbiol Infect. 2019; 25:26–34.
Article
5. Cornely OA, Alastruey-Izquierdo A, Arenz D, et al. Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the mycoses study group education and research consortium. Lancet Infect Dis. 2019; 19:e405–e421.
6. Roden MM, Zaoutis TE, Buchanan WL, et al. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis. 2005; 41:634–653.
Article
7. Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020; 382:1708–1720.
Article
8. Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun. 2020; 109:102433.
Article
9. Moura DTH, McCarty TR, Ribeiro IB, et al. Diagnostic characteristics of serological-based COVID-19 testing: a systematic review and meta-analysis. Clinics (Sao Paulo). 2020; 75:e2212.
Article
10. Broughton JP, Deng X, Yu G, et al. CRISPR-Cas12-based detection of SARS-CoV-2. Nat Biotechnol. 2020; 38:870–874.
Article
11. Song G, Liang G, Liu W. Fungal co-infections associated with global COVID-19 pandemic: a clinical and diagnostic perspective from China. Mycopathologia. 2020; 185:599–606.
Article
12. Riley TT, Muzny CA, Swiatlo E, Legendre DP. Breaking the mold: a review of mucormycosis and current pharmacological treatment options. Ann Pharmacother. 2016; 50:747–757.
13. Cherney CL, Chutuape A, Fikrig MK. Fatal invasive gastric mucormycosis occurring with emphysematous gastritis: case report and literature review. Am J Gastroenterol. 1999; 94:252–256.
Article
14. de Moura DTH, Proença IM, McCarty TR, et al. Gastrointestinal manifestations and associated health outcomes of COVID-19: a Brazilian experience from the largest South American public hospital. Clinics (Sao Paulo). 2020; 75:e2271.
Article
15. Petrikkos G, Skiada A, Lortholary O, Roilides E, Walsh TJ, Kontoyiannis DP. Epidemiology and clinical manifestations of mucormycosis. Clin Infect Dis. 2012; 54(Suppl 1):S23–S34.
Article
16. Spellberg B, Walsh TJ, Kontoyiannis DP, Edwards J Jr, Ibrahim AS. Recent advances in the management of mucormycosis: from bench to bedside. Clin Infect Dis. 2009; 48:1743–1751.
Article
17. Salehi M, Ahmadikia K, Badali H, Khodavaisy S. Opportunistic fungal infections in the epidemic area of COVID-19: a clinical and diagnostic perspective from Iran. Mycopathologia. 2020; 185:607–611.
Article
18. Chen G, Wu D, Guo W, et al. Clinical and immunological features of severe and moderate coronavirus disease 2019. J Clin Invest. 2020; 130:2620–2629.
Article
19. Koehler P, Cornely OA, Böttiger BW, et al. COVID-19 associated pulmonary aspergillosis. Mycoses. 2020; 63:528–534.
Article
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