Korean J Gastroenterol.  2023 May;81(5):221-225. 10.4166/kjg.2023.015.

Case Reports on Black Fungus of the Gastrointestinal Tract: A New Complication in COVID-19 Patients

• Arora S
• Singh A
• Prasad P
• R
• Singh R

• KMID: 2542789
• DOI: http://doi.org/10.4166/kjg.2023.015

Abstract

Gastrointestinal mucormycosis is a rare disease with a significant mortality rate, even when promptly diagnosed and treated. An unusual complication was observed in India during the second wave of coronavirus disease 2019 (COVID-19). Two incidences of gastric mucormycosis were found. A 53-year-old male patient with a history of COVID-19 one month earlier came into the intensive care unit. After admission, the patient developed hematemesis, which was initially treated with blood transfusions and digital subtraction angiography embolization. Esophagogastroduodenoscopy (EGD) revealed a large ulcer with a clot in the stomach. During an exploratory laparotomy, the proximal stomach was necrotic. Histopathological examination confirmed mucormycosis. The patient was started on antifungals, but despite rigorous therapy, the patient died on the tenth postoperative day. Another patient, an 82-year-old male with a history of COVID-19, arrived with hematemesis two weeks earlier and was treated conservatively. EGD revealed a large white-based ulcer with abundant slough along the larger curvature of the body. Mucormycosis was verified by biopsy. He was treated with amphotericin B and isavuconazole. He was discharged after two weeks in a stable condition. Despite quick detection and aggressive treatment, the prognosis is poor. In the second case, prompt diagnosis and treatment saved the patient’s life.

Keyword

COVID-19; Coronavirus; Mucormycosis; Fungus; Amphotericin B

Figure

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  Fig. 1 CT images showing a gastropleural fistula with left-sided hydropneumothorax (A and B). A triple-phase computed tomography of the abdomen demonstrated no obvious contrast extravasation or pseudoaneurysm, with a non-enhancing stomach wall at the fundus, adherent to the left hemidiaphragm, and gastro pleural connection with a left-sided hydropneumothorax. Circle in the picture showing gastro pleural connection with left-sided hydropneumothorax.

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  Fig. 2 Intra-operative image showing a necrosed proximal stomach and large diaphragmatic defect. Blood clots (500 g) were observed in the left subdiaphragmatic region. The proximal stomach was necrotic, which included the cardia, fundus, and proximal section of the greater curvature. A diaphragmatic defect with a diameter of around 5 cm is evident. Circle in the picture showing the diaphragmatic defect.

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  Fig. 3 Section from a gastrectomy specimen showing numerous broad, aseptate fungal profiles, suggesting mucormycosis (PAS, ×20).

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  Fig. 4 Photomicrograph showing angioinvasion by the funga elements. (H&E, ×40).

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  Fig. 5 Large white-based ulcer with plenty of sloughs along the greater curvature in the body region (A and B). Arrow in the picture showing white based ulcer with slough.

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  Fig. 6 Section from gastric biopsy showing numerous, broad, aseptate, hyaline fungal profiles identified in an area of necrosis. (H&E, ×40).

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  Fig. 7 CT image showing hypodense non-enhancing mottled air containing a slough-like lesion adherent to the gastric wall along the greater curvature. Circle in the picture showing hypodense non-enhancing mottled air containing a slough-like lesion.

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