S3108 Case Report: Medically Managed Invasive Gastric Mucormycosis in a Non-Diabetic Patient With Alcohol Use Disorder

Abstract

Introduction: Mucormycosis is an uncommon but often fatal fungal infection caused by species in the Mucorales order of fungi. The main mode of transmission is airborne, thus sinopulmonary complications are common (2). Infections involving the gastrointestinal tract rarely occur but are associated with extremely high mortality (1). Although rare, gastrointestinal mucormycosis has been reported in association with immunocompromised patients and diabetics (1). There are few reports of successfully treated gastric mucormycosis, most involving surgical interventions. Most patients with this disease in these limited reports unfortunately pass from overwhelming sepsis. This case vignette discusses a patient successfully treated solely with antifungal therapy. Case Description/Methods: A 32 year old male with alcohol abuse and Kratom use was initially hospitalized for 7 days for acute alcoholic pancreatitis and discharged with steroids due to concern for alcoholic hepatitis. On day 14 of steroids, he was readmitted for acute blood loss anemia requiring transfusion. Initial esophagogastroduodenoscopy (EGD) showed gastric mucormycosis on biopsy of a 3 cm gastric fundal ulcer. Screening for additional risk factors was unremarkable, including an A1c of 5.5%. He was started on Amphotericin B and a second EGD showed improvement in the ulcer. Outpatient, he tolerated Amphotericin B well with minimal complications. A third EGD was done outpatient two weeks later with continued ulcer improvement. After completing a four week course of Amphotericin B, he was transitioned to Posaconazole for maintenance therapy. During another admission for alcoholic pancreatitis, a fourth EGD showed further resolution of his ulcer. He was discharged with a three month course of posaconazole. Discussion: While rhinocerebral and pulmonary mucormycosis are more common, angioinvasive GI disease can also occur. Risk factors include diabetes (especially DKA), immunosuppression, and alcohol abuse (3). Regarding this case, risk factors include the patient’s history of alcohol abuse and recent steroid use for suspected alcoholic hepatitis. Kratom use could also be considered an exposure risk factor although studies are limited. This case report is unique in that a patient was successfully treated solely with anti-fungal therapy, which is unconventional as surgical intervention is usually required.