Gastrointestinal Mucormycosis and Presumptive Vibriosis in a Welder, a Case Report

Abstract

When iron homeostasis is disrupted in overload states, siderophilic pathogens may display increased virulence including Vibrio and Mucorales species, among others. We present a case of widely disseminated Mucormycosis and presumed Vibriosis in a welder with severe sepsis of unknown origin despite thorough evaluation. The diagnosis of Mucormycosis was not ascertained until the day of the patient’s passing, illustrating the importance of considering iron overload and associated infections in the differential diagnosis of at-risk patients, such as a welder, who developed elusive and undifferentiated sepsis unresponsive to conventional therapy. A 50-year-old male welder developed two episodes of acute gastrointestinal illness and subacute distal foot pain after traveling to coastal California and raw oyster consumption. His illness progressed over 3 weeks leading to hospitalization with mixed septic and cardiogenic shock. He initially improved with cardiac support and empiric treatment for presumed Vibriosis; however, his clinical status proceeded to deteriorate once more. He developed an acute abdomen, and during an emergent exploratory laparotomy, he was found to have widely disseminated, gastrointestinal Mucormycosis. After surgery, the patient transitioned to comfort measures and passed away several hours later. History of welding in a patient presenting with sepsis should prompt consideration of systemic iron overload and evaluation, as well as associated infections such as siderophilic pathogens, which may otherwise remain elusive and potentially fatal if not considered on the differential diagnosis. This is of particular importance in patients who have ongoing, undifferentiated sepsis with failure to stabilize despite standard-of-care comprehensive evaluation and therapeutics.