Abstract
A 57 years female from the hills of Nepal presented with upper gastrointestinal bleeding with gastric ulcer evident on endoscopy. Though initially treated with Helicobacter pylori ( H. pylori) eradication therapy alone, biopsy later on revealed both mucormycosis and H. pylori infection. She was then treated with antifungals liposomal amphotericin B followed by posaconazole which led to complete recovery. Mucormycosis is a rare but life-threatening fungal disease of immunocompromised host though our patient was immunocompetent. If recognized and treated at early stage, as in our patient, prognosis is good. A high index of suspicion is required for considering this disease in H. pylori endemic regions such as Nepal, and is crucial for early recognition and treatment.
Highlights
Upper gastrointestinal bleeding is a common medical emergency which is usually treated with initial stabilization followed by upper gastrointestinal endoscopy
Peptic ulcer disease is a common finding in endoscopy which is usually associated with infection with Helicobacter pylori (H. pylori
Our patient presented with upper gastrointestinal bleed, and received H. pylori eradication treatment empirically after ulcer was evident on endoscopy
Summary
Upper gastrointestinal bleeding is a common medical emergency which is usually treated with initial stabilization followed by upper gastrointestinal endoscopy. Case report A 57 years old, smoker female from Sindhuli, a hilly district of Nepal, with no known comorbidities, presented to the Emergency Department of Patan Hospital, Lagankhel, Lalitpur in April of 2018 with one day history of two episodes of bright red blood-mixed vomitus (around 500 ml per episode), but she had dyspepsia, malena and fatigability for 4 months duration On assessment, she was pale with blood pressure of 90/50 mmHg and heart rate of 130 beats per minute. She was started on triple therapy regimen empirically for H. pylori eradication containing clarithromycin 500 mg, amoxicillin 1 gm and pantoprazole 40 mg twice daily for 14 days, and discharged When she returned for follow-up, the histopathology showed fungi with broad ribbon like morphology, fruiting bodies consistent with mucor in the ulcer, as well as in granulation tissue suggesting fungal invasion but no necrosis or vascular thrombi (Figure 1). She was doing well when she was last followed up in October 2018
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
