Gastric mucormycosis as a rare cause of gastric mucosal sloughing and gastrointestinal bleeding: A case report
This case report describes a fatal instance of gastric mucormycosis causing severe mucosal sloughing and gastrointestinal bleeding in a 75-year-old immunocompromised male on biologic therapy, highlighting the critical need for early endoscopic diagnosis and aggressive intervention in similar high-risk patients.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Inside the human body, the immune system acts as a constant defense force, patrolling for invaders like bacteria and fungi that try to take hold. Usually, this system keeps such threats in check, but when a person's defenses are weakened by illness or medication, even common environmental fungi can become dangerous. One such group of fungi, known as Mucorales, lives widely in soil and decaying matter. While harmless to most, these organisms can cause a severe and rapidly spreading infection called mucormycosis if they enter the body of someone with a compromised immune system. This infection is particularly feared because the fungi have a unique ability to invade blood vessels, cutting off blood supply to tissues and causing them to die quickly. While this condition is most often associated with the sinuses or lungs, it can occasionally strike the digestive tract, a scenario that is difficult to recognize and even harder to treat.
This story begins with a seventy-four-year-old man who arrived at a hospital in Qingdao, China, suffering from a high fever, muscle pain, and a swollen belly. He had a long history of psoriasis, a skin condition, and had been taking powerful medications for three years to keep it under control. These drugs, which include secukinumab and apremilast, work by calming the immune system, but in this case, they may have left him vulnerable. Upon admission, doctors found he was in a state of sepsis, a life-threatening reaction to an infection that had spread through his blood. His lungs showed signs of pneumonia, and his blood tests revealed that his heart, liver, and kidneys were all struggling. Doctors treated him with strong antibiotics for a bacterial infection they found in his blood, and for a short time, his condition seemed to improve.
However, the patient's situation took a sharp turn when he began passing dark, bloody stool and his blood levels dropped dangerously low. This signaled a severe bleed somewhere in his upper digestive tract. An emergency camera examination of his stomach revealed the source of the trouble: a massive area of tissue damage. Instead of a simple sore, doctors found a large patch of the stomach lining, measuring four centimeters by five centimeters, that had peeled away entirely. This area, located near the lower part of the stomach, stretched from the front wall to the back wall. The exposed base of the wound looked raw and was oozing blood, with some areas showing the deep muscle layer of the stomach wall.
To understand what was causing this destruction, doctors took small samples of the tissue from the edge of the wound. Under a microscope, the answer became clear. The tissue was not just inflamed; it was being eaten away by a fungal infection. The samples showed broad, thread-like structures consistent with the Mucorales family of fungi. This confirmed a diagnosis of gastric mucormycosis, a rare and aggressive infection of the stomach lining. The fungi had invaded the blood vessels in the stomach wall, causing the tissue to die and slough off, which led to the severe bleeding.
Once the diagnosis was made, the medical team moved quickly to fight the infection. They started the patient on a potent antifungal medication called liposomal amphotericin B, which is the standard treatment for this type of fungus. Within two days, they also performed a major surgery to remove the damaged part of the stomach, hoping to cut out the source of the infection before it could spread further. Despite these aggressive efforts, the patient's body could not recover. He continued to lose blood and his inflammatory markers remained high. About one month after the surgery, his condition worsened rapidly, leading to the failure of multiple organs, and he passed away.
This case highlights the extreme danger of gastric mucormycosis, especially in patients whose immune systems are suppressed by long-term medication. The infection is difficult to spot because its early signs, such as stomach pain or bleeding, can look like many other common digestive problems. The key lesson from this report is that for patients with weakened immune systems who develop unexplained bleeding or severe stomach issues, doctors must consider this rare fungal infection as a possibility. The examination of the stomach lining with a camera and the microscopic analysis of tissue samples are critical steps to catch the disease early. While surgery and strong antifungal drugs offer the best chance for survival, the outcome remains uncertain, and the infection often proves fatal if not identified and treated immediately.
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