2746 Medical Management of Gastric Mucormycosis in an Immunocompetent Patient

Abstract

INTRODUCTION: Mucormycosis is a rare and life-threatening cause of invasive fungal infection largely found in immunocompromised patients. Prevalence has increased in patients without risk factors. This is a case of an otherwise healthy female, found to have invasive gastric mucormycosis, and her medical management. CASE DESCRIPTION/METHODS: 54-year-old non-diabetic Ethiopian female with PMH HTN was admitted to the hospital with 2 months of nausea, vomiting, abdominal pain, fever, and melena. She reports use of omeprazole up to 4 times daily with no improvement. Pertinent findings include Temp 104 F, NIBP 90/40. Physical exam showed diffuse tenderness of the abdomen worse in epigastrium. WBC 22.8; other labs were normal. EGD showed a wide patch of necrotic and edematous folds of the fundus and proximal body of the stomach as well as submucosal hemorrhage in the fundus. Petechiae were seen in the antrum. Fundal biopsies were obtained, which showed invasive fungal hyphae, described as broad, non-septate, with branching consistent with the Mucor genus. Testing for TB, HIV, malaria, malignancy were negative. Fungal blood cultures were negative. Bone marrow biopsy was negative. Her only travel outside of the US in the last 10 years was to Ethiopia about 2 years prior. Her only non-US food source were chili peppers imported from Ethiopia. A course of liposomal amphotericin was recommended for 8 weeks for the mucor. Surgery recommended no intervention unless the patient developed peritonitis. She will be transitioned to oral posaconazole upon completion of the amphotericin. Her presenting symptoms, labs, and vitals have normalized. DISCUSSION: Mucormycosis is an uncommon cause of fungal infections of the GI tract with a high mortality. Most cases involve diabetics, neutropenic adults, immunocompromised patients, hematologic malignancy, or premature neonates. Our patient didn’t fall into any of these categories. The GI tract is only involved in approximately 7% of cases. The stomach being most common (58%) followed by the colon (32%). Endoscopic biopsy is needed for diagnosis where fungal hyphae are seen. Fungal cultures are positive in only 50% of cases. Because of the high risk of perforation and exsanguination, a combined approach of surgical and medical treatment is recommended. In this case, surgical intervention was only recommended in the case of an emergency. This patient without known risk factors for mucormycosis clinically improved without surgical resection.