View Abstract

A5178 - Massive Bleed from Invasive Gastrointestinal Mucormycosis in an Immunocompetent Patient
Author Block: D. Kay1, N. Dillow2, R. G. Valentin3, L. A. Benninger3, C. A. Trillo3; 1Pulmonary and Critical Care, University of Florida, Gainesville, FL, United States, 2Medicine, University of Florida, Gainesville, FL, United States, 3University of Florida, Gainesville, FL, United States.
Mucormycosis is a life-threatening infection that has been known to develop in immunodeficient patients. Common risk factors of invasive mucormycosis include hematologic malignancies, defective phagocytes, chronic corticosteroid use, and organ or stem cell transplantation. Mucormycosis can affect any organ system, but the most common presentations involve the nasal sinuses, orbit, and brain (rhino-orbital-cerebral) or the lung. We present a rare case of gastrointestinal mucormycosis in an immunocompetent patient leading to massive hemorrhage.
Our case is of a 69 year old female with past medical history of hyperlipidemia, hepatitis C with cirrhosis, hypertension, coronary artery disease, and well-controlled diabetes who was initially admitted due to statin rhabdomyolysis which resulted in renal failure making the patient dialysis dependent. Over the course of her admission, she developed thrombocytopenia, leukocytosis, disseminated intravascular coagulation and worsening mental status, raising concern for sepsis. She was treated with broad-spectrum antibiotics and provided with supportive care. She began having recurrent melanotic stools as well as bright red blood per rectum. Flexible sigmoidoscopy showed an ulceration in the rectum, pathology consistent with inflammation and ulceration. Due to recurrent hematochezia and requirements for large volume transfusions, the patient underwent an Esophagogastroduodenoscopy (EGD) with biopsy of a fungating stomach lesion which showed zygomycosis under microscopy. Upon further evaluation, she was deemed to not be an operative candidate. The patient was started on treatment with Amphotericin B and Fluconazole, with Fluconazole discontinued after 24 hours. She remained on piperacillin-tazobactam and Vancomycin. Progressive deterioration of her hemodynamic status due to hemorrhagic shock led to a decision by the patient’s family to withdraw care.
Although, gastrointestinal mucormycosis was previously viewed as a rare infection, in a recent review of the literature it has been shown to have become more prevalent. Initially, gastrointestinal mucomycosis was described in premature infants and neonates. Later, more cases were described in immunodeficient patients, including those with AIDS, malignancies, and solid organ transplantation. Most recently, cases of such an infection have been described in patients with no predisposing risk factors or common risk factors such as diabetes mellitus, corticosteroid use, or peptic ulcer disease. Hence, it is important to be aware of the increasing prevalence of gastrointestinal mucormycosis especially considering the high mortality with which this infection is associated.