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Ji R. Mucormycosis mimicking portal hypertensive haemorrhage as a complication of alcoholic liver cirrhosis: a case report. BMC Infect Dis 2024; 24:136. [PMID: 38287258 PMCID: PMC10823596 DOI: 10.1186/s12879-023-08220-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 04/04/2023] [Indexed: 01/31/2024] Open
Abstract
Mucor is a rare cause of gastrointestinal ulcers. This case describes a case of mucormycosis that occurred in a patient with liver cirrhosis who was hospitalized to accept a splenectomy for traumatic splenic rupture. During the perioperative period, the patient developed upper gastrointestinal bleeding(UGIB), which was diagnosed as mucormycosis-related gastric ulcer according to gastroscopy. Patients with liver cirrhosis often get UGIB for Portal hypertension, but they also can develop UGIB for multiple other reasons, including infectious ulcers for immunosuppression. The case emphasizes the importance of excluding fungal-induced ulcer haemorrhage before diagnosing Portal hypertensive-induced variceal haemorrhage in patients with liver cirrhosis.
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Affiliation(s)
- Ran Ji
- Department of the Surgical Intensive Care Unit (SICU), The Second Affiliated Hospital Zhejiang, University School of Medicine, NO. 88 Jiefang Road,Shangcheng District Hangzhou, 310009, Zhejiang, China.
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2
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Sosnowska-Sienkiewicz P, Błaszczyk K, Kubisiak-Rzepczyk H, Mańkowski P, Januszkiewicz-Lewandowska D. How to Treat a Child With a Concurrent Diagnosis of Leukemia and Generalized Mucormycosis? Case Report. Front Med (Lausanne) 2022; 9:844880. [PMID: 35280905 PMCID: PMC8914026 DOI: 10.3389/fmed.2022.844880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/03/2022] [Indexed: 11/13/2022] Open
Abstract
Mucormycosis is a rare but a devastating and lifethreatening fungal infection caused by fungi of the order Mucorales usually in immunocompromised patients. Depending on the organs and tissues involved, there are sinus, pulmonary, gastrointestinal, orbital, cerebral, cutaneous and disseminated mucormycosis. Only sporadic cases of hepatic mucormycosis have been described. Hence, we present a complicated treatment management in a 16-month-old child with leukemia and generalized mucormycosis localized in the liver and in the gastrointestinal tract. The collaboration of a multidisciplinary team and appropriate therapy gave a chance not only to save the patient's life, but to carry out anticancer treatment, which resulted in leukemia remission. A 6-month course of isavuconazole and amphotericin B liposomal as well as surgical treatment led to the cure of the fungal infection.
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Affiliation(s)
- Patrycja Sosnowska-Sienkiewicz
- Department of Pediatric Surgery, Traumatology and Urology, Poznan University of Medical Sciences, Poznan, Poland
- *Correspondence: Patrycja Sosnowska-Sienkiewicz
| | | | | | - Przemysław Mańkowski
- Department of Pediatric Surgery, Traumatology and Urology, Poznan University of Medical Sciences, Poznan, Poland
| | - Danuta Januszkiewicz-Lewandowska
- Department of Medical Diagnostic, Poznan, Poland
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
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3
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Didehdar M, Chegini Z, Moradabadi A, Anoushirvani AA, Tabaeian SP, Yousefimashouf M, Shariati A. Gastrointestinal mucormycosis: A periodic systematic review of case reports from 2015 to 2021. Microb Pathog 2022; 163:105388. [PMID: 34995749 DOI: 10.1016/j.micpath.2022.105388] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/01/2022] [Accepted: 01/01/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND GI mucormycosis (GI) is a rare but highly lethal infection in patients. There is no single comprehensive review of the literature that demonstrates the various clinical aspects of this infection. METHODS A structured search of PubMed/Medline was used to collect case reports of GI mucormycosis in patients of all ages published between 2015 and November 2021. RESULTS Eighty-seven cases were identified through PubMed bibliographic database searches, and final analyses were conducted on 70 adults and ten neonatal patients with GI mucormycosis. Asia had the highest number of reported cases, with 46 (57.5%). Neonatal cases had a mortality rate of 70%, while other cases had a mortality rate of 44%. Corticosteroid therapy and diabetes were the most significant risk factors in patients, while 11% were immunocompetent with no apparent underlying condition. COVID-19 positivity was detected in four adult patients. Moreover, neonatal cases included premature and low-weight infants, metabolic acidosis, and malnutrition. Abdominal pain, fever, and GI perforation were the most common signs of infection, while vomiting occurred in 40% of neonatal cases. In 97% of patients, a histopathologic examination was used to detect infection, whereas culture and molecular methods were used in only 28% and 17% of patients, respectively. Surgery plus anti-infection therapy, anti-infection therapy alone, and surgery alone were used in 61%, 28%, and 11% of patients, respectively. Nonetheless, all neonatal patients underwent surgery. Although used in a small number of patients, posaconazole (30%) and isavuconazole (11%) demonstrated high efficacy in treating patients. CONCLUSION GI mucormycosis is a rare but highly lethal disease. Treatment of underlying conditions, the use of multiple diagnostic techniques, and appropriate antifungals in conjunction with surgery can all contribute to infection control.
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Affiliation(s)
- Mojtaba Didehdar
- Department of Medical Parasitology and Mycology, Arak University of Medical Sciences, Arak, Iran
| | - Zahra Chegini
- Department of Microbiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Alireza Moradabadi
- Molecular and medicine Research Center, Khomein University of Medical Sciences, Khomein, Iran; Department of medical Laboratory Sciences, Khomein University of Medical Sciences, Khomein, Iran
| | - Ali Arash Anoushirvani
- Department of Internal Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seidamir Pasha Tabaeian
- Department of Internal Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran; Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Milad Yousefimashouf
- Department of Medical Laboratory Sciences, Faculty of Paramedical, Borujerd Branch, Islamic Azad University, Borujerd, Iran
| | - Aref Shariati
- Molecular and medicine Research Center, Khomein University of Medical Sciences, Khomein, Iran; Department of medical Laboratory Sciences, Khomein University of Medical Sciences, Khomein, Iran.
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4
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Unusual manifestation of gastric mucormycosis in a patient with rheumathoid arthritis. VOJNOSANIT PREGL 2022. [DOI: 10.2298/vsp200731020m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction. Mucormycosis is a life-threatening opportunistic infection whose incidence has significantly risen during the last two decades. The gastrointestinal form is very rare, with the stomach as the most common site of infection, followed by the colon and ileum. Risk factors include uncontrolled diabetes mellitus, corticosteroid use, and organ transplantation. We report a patient with a history of rheumatoid arthritis who has developed gastrointestinal mucormycosis. To the best of our knowledge, this is the first such case reported in the literature. Case report. A 53-year-old female patient with a prior medical history of rheumatoid arthritis was admitted to the hospital due to persisting diarrhea. Physical examination revealed diffuse abdominal tenderness to palpation without meteorism and peritoneal signs. Laboratory results demonstrated systemic inflammation, so antibiotic therapy was administered. Abdominal computed tomography findings revealed inflammation of the rectum and the left colon. Colonoscopy findings were indicative of Crohn?s disease. Additionally, the patient had developed profuse rectal bleeding and consequently underwent emergency surgery. Subtotal colectomy with ileostomy and partial gastrectomy was performed. The patient?s condition rapidly worsened after the operation, and she died due to multi-organ failure. Histologic findings of resection specimens discovered chronic active colitis and extensive gastric necrosis associated with dense mixed inflammatory infiltration and numerous non-septate and 90-degree branching hyphae. Diagnosis of invasive gastric mucormycosis was obtained, but unfortunately, several days after the patient?s death. Conclusion. It is very important to obtain high awareness among clinicians of this deadly infection to achieve a prompt diagnosis and effective therapy.
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Chung S, Sung HJ, Chang JW, Hur I, Kim HC. A Fatal Case of Disseminated Intestinal Mucormycosis in a Patient with Vibrio Sepsis. JOURNAL OF ACUTE CARE SURGERY 2021. [DOI: 10.17479/jacs.2021.11.3.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Mucormycosis is a fungal infection that primarily causes opportunistic infections. Gastrointestinal mucormycosis is a rare infection that can occur in immunocompromised patients, nevertheless, prompt diagnosis and treatment is essential because it can be fatal. Gastrointestinal mucormycosis can only be diagnosed based on the findings of a pathological examination. Mucormycosis should be included in the differential diagnosis if the condition of patients with underlying immunocompromised conditions or diseases does not improve with general intensive care.
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Jung H, Kim GJ, Oh TH. Successful Management of a Rare Gastric Mucormycosis Presenting with Massive Melena in a Polytrauma Patient. Int Med Case Rep J 2020; 13:531-535. [PMID: 33116945 PMCID: PMC7585504 DOI: 10.2147/imcrj.s279495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/07/2020] [Indexed: 02/02/2023] Open
Abstract
Mucormycosis is a rare, life-threatening, and opportunistic fungal infection that usually occurs in immunocompromised patients. Rhinocerebral and pulmonary manifestations are the common form. The rare form of gastrointestinal mucormycosis occur in all parts of the alimentary tract, with emphasis on the stomach being the most common site. Primary gastric mucormycosis following traumatic injury is an extremely rare form that is usually lethal; thus, only a few cases of survival have been reported even after early diagnosis and aggressive surgical resection, combined with antifungal treatment. We herein report a case of delayed-onset gastric mucormycosis in a polytrauma patient without predisposing factors, which was successfully treated by antifungal medical therapy alone with no surgical debridement.
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Affiliation(s)
- Hanna Jung
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Gun Jik Kim
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Tak-Hyuk Oh
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Republic of Korea
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Gastric Mucormycosis: An Infection of Fungal Invasion into the Gastric Mucosa in Immunocompromised Patients. Case Rep Gastrointest Med 2020; 2020:8876125. [PMID: 33014480 PMCID: PMC7516694 DOI: 10.1155/2020/8876125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 01/28/2023] Open
Abstract
Primary gastric mucormycosis is a rare but potentially lethal fungal infection due to the invasion of Mucorales into the gastric mucosa. It may result in high mortality due to increased risk of complications in immunocompromised patients. Common predisposing risk factors to develop gastric mucormycosis are prolonged uncontrolled diabetes mellitus with or without diabetic ketoacidosis (DKA), solid organ or stem cell transplantation, underlying hematologic malignancy, and major trauma. Abdominal pain, hematemesis, and melena are common presenting symptoms. The diagnosis of gastric mucormycosis can be overlooked due to the rarity of the disease. A high index of suspicion is required for early diagnosis and management of the disease, particularly in immunocompromised patients. Radiological imaging findings are nonspecific to establish the diagnosis, and gastric biopsy is essential for histological confirmation of mucormycosis. Prompt treatment with antifungal therapy is the mainstay of treatment with surgical resection reserved in cases of extensive disease burden or clinical deterioration. We presented a case of acute gastric mucormycosis involving the body of stomach in a patient with poorly controlled diabetes and chronic renal disease, admitted with acute onset of abdominal pain. Complete resolution of lesion was noted with 16 weeks of medical treatment with intravenous amphotericin B and posaconazole.
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Huang YQ, Tremblay JA, Chapdelaine H, Luong ML, Carrier FM. Pulmonary mucormycosis in a patient with acute liver failure: A case report and systematic review of the literature. J Crit Care 2019; 56:89-93. [PMID: 31881411 DOI: 10.1016/j.jcrc.2019.12.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 12/05/2019] [Accepted: 12/11/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE Pulmonary mucormycosis is a highly lethal invasive fungal infection usually found in immunocompromised patients. We report herein the case of an adult woman who developed pulmonary mucormycosis with possible systemic dissemination after recovering from acute liver failure secondary to acetaminophen overdose. RESULTS Our case developed an invasive pulmonary mucormycosis with probable systemic dissemination. She did not suffer from any immunocompromising disease other than severe acute liver failure. She did not survive the disease, although she received appropriate antifungal treatment. We also performed a systematic review of the literature on pulmonary mucormycosis, with or without dissemination, in immunocompetent patients. We found 16 cases of pulmonary or disseminated mucormycosis in immunocompetent patients. Fifty-seven percent of them died and none occurred after an acute liver failure episode. CONCLUSION This case report is the first one to present an invasive pulmonary mucormycosis infection after acute liver failure in an adult patient. The clinical course of this disease is highly lethal, even in immunocompetent adults.
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Affiliation(s)
- Yu Qing Huang
- Department of Medicine, University of Montreal, Canada
| | | | - Hugo Chapdelaine
- Department of Medicine, Division of Immunology, University of Montreal Hospital Centre, Canada; University of Montreal Hospital Research Center, Canada; Montreal Clinical Research Institute, Canada
| | - Me-Linh Luong
- University of Montreal Hospital Research Center, Canada; Department of Medicine, Division of Infectious diseases, University of Montreal Hospital Centre, Canada
| | - François Martin Carrier
- University of Montreal Hospital Research Center, Canada; Department of Anesthesiology and Department of Medicine, Division of Critical Care, University of Montreal Hospital Centre, Canada.
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Emphysematous Gastritis in a Patient with Untreated Cyclic Vomiting Syndrome. ACG Case Rep J 2018; 5:e90. [PMID: 30775393 PMCID: PMC6358574 DOI: 10.14309/crj.2018.90] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 09/11/2018] [Indexed: 12/11/2022] Open
Abstract
Emphysematous gastritis (EG) is an uncommon and potentially fatal disease characterized by gastric pneumatosis in the setting of infection. While this disease has been described in the literature, it has not previously been identified as a potential complication of cyclic vomiting syndrome. We describe a patient with a history of cyclic vomiting syndrome who presented acutely ill and was found to have radiographic, endoscopic, and histologic evidence of EG. This case illustrates how an untreated functional bowel disorder can lead to severe and potentially fatal complications.
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10
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Kaur H, Ghosh A, Rudramurthy SM, Chakrabarti A. Gastrointestinal mucormycosis in apparently immunocompetent hosts—A review. Mycoses 2018; 61:898-908. [DOI: 10.1111/myc.12798] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/09/2018] [Accepted: 05/25/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Harsimran Kaur
- Department of Medical MicrobiologyPostgraduate Institute of Medical Education and Research PGIMER Chandigarh India
| | - Anup Ghosh
- Department of Medical MicrobiologyPostgraduate Institute of Medical Education and Research PGIMER Chandigarh India
| | - Shivaprakash M. Rudramurthy
- Department of Medical MicrobiologyPostgraduate Institute of Medical Education and Research PGIMER Chandigarh India
| | - Arunaloke Chakrabarti
- Department of Medical MicrobiologyPostgraduate Institute of Medical Education and Research PGIMER Chandigarh India
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11
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Termos S, Othman F, Alali M, Al Bader BMS, Alkhadher T, Hassanaiah WF, Taqi A, Sapkal A. Total Gastric Necrosis Due to Mucormycosis: A Rare Case of Gastric Perforation. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:527-533. [PMID: 29724988 PMCID: PMC5956728 DOI: 10.12659/ajcr.908952] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Female, 52 Final Diagnosis: Gastric mucormycosis Symptoms: Sepsis • surgical abdomen Medication: Liposomal amphotericine b Clinical Procedure: Total gastrectomy Specialty: Surgery
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Affiliation(s)
- Salah Termos
- Department of Surgery, Al-Amiri Hospital, Kuwait City, Kuwait
| | - Feras Othman
- Department of Surgery, Al-Amiri Hospital, Kuwait City, Kuwait
| | - Mohammad Alali
- Department of Surgery, Al-Amiri Hospital, Kuwait City, Kuwait
| | | | - Talal Alkhadher
- Department of Surgery, Al-Amiri Hospital, Kuwait City, Kuwait
| | | | - Ali Taqi
- Department of Surgery, Al-Amiri Hospital, Kuwait City, Kuwait
| | - Abhijit Sapkal
- Department of Pathology, Al-Amiri Hospital, Kuwait City, Kuwait
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12
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Persichino JG, Can AD, Van TT, Matthews MN, Filler SG. Invasive pulmonary mucormycosis and aspergillosis in a patient with decompensated hepatic cirrhosis. Med Mycol Case Rep 2018; 21:12-15. [PMID: 29560305 PMCID: PMC5857481 DOI: 10.1016/j.mmcr.2018.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 02/09/2018] [Accepted: 03/01/2018] [Indexed: 12/15/2022] Open
Abstract
Invasive pulmonary mucormycosis and aspergillosis are rare, life-threatening fungal infections. Most documented cases have been reported in non-cirrhotic patients with diabetes mellitus, neutropenia, or treatment with corticosteroids. The prevalence of each infection is low among patients with hepatic cirrhosis. We report the first likely case of combined invasive pulmonary mucormycosis and aspergillosis in a male with decompensated hepatic cirrhosis. This report also highlights the first non-diabetic case of invasive pulmonary mucormycosis with decompensated hepatic cirrhosis.
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Affiliation(s)
- Jon G. Persichino
- Harbor-UCLA Medical Center, Division of Infectious Diseases, 1000 West Carson Street, Torrance, CA 90509, USA
- Corresponding author.
| | - Argun D. Can
- Harbor-UCLA Medical Center, Division of Respiratory & Critical Care Physiology & Medicine, 1000 West Carson Street, Torrance, CA 90509, USA
| | - Tam T. Van
- Harbor-UCLA Medical Center, Department of Pathology, 1000 West Carson Street, Torrance, CA 90509, USA
| | - Michele N. Matthews
- Harbor-UCLA Medical Center, Department of Pathology, 1000 West Carson Street, Torrance, CA 90509, USA
| | - Scott G. Filler
- Harbor-UCLA Medical Center, Division of Infectious Diseases, 1000 West Carson Street, Torrance, CA 90509, USA
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14
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Emphysematous Gastritis in a Patient with Untreated Cyclic Vomiting Syndrome. ACG Case Rep J 2018. [DOI: 10.14309/02075970-201805120-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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15
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Tathe SP, Dani AA, Chawhan SM, Meshram SA, Randale AA, Raut WK. Gastric mucormycosis: Diagnosis by imprint cytology. Diagn Cytopathol 2016; 44:820-2. [PMID: 27321416 DOI: 10.1002/dc.23518] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/26/2016] [Accepted: 06/06/2016] [Indexed: 12/16/2022]
Abstract
The fungi in the order of Mucorales commonly target diabetics and other immunocompromised hosts, producing fatal respiratory and or CNS infections. Gastrointestinal mucormycosis is uncommon and seldom diagnosed in living patients due to nonspecific clinical manifestations. We report a case of gastric mucormycosis in an immmunocompetent male patient, diagnosed by imprint cytology-a rare site and a rare setting. To the best of our knowledge, this is only the second report of gastric mucormycosis being diagnosed on cytology. As the disease is rapidly progressive and often fatal, early diagnosis is critical to the patient survival. Imprint cytology or brush cytology is extremely useful for the rapid diagnosis of gastric mucormycosis as these organisms are morphologically distinct. Familiarity with the cytomorphology of these organisms assists in the correct diagnosis of this disease. Diagn. Cytopathol. 2016;44:820-822. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Shilpa P Tathe
- Department of Pathology, Superspeciality Hospital and Government Medical College, Nagpur, Maharashtra, India.
| | - Aarti A Dani
- Department of Pathology, Superspeciality Hospital and Government Medical College, Nagpur, Maharashtra, India
| | - Sanjay M Chawhan
- Department of Pathology, Superspeciality Hospital and Government Medical College, Nagpur, Maharashtra, India
| | - Saroj A Meshram
- Department of Pathology, Superspeciality Hospital and Government Medical College, Nagpur, Maharashtra, India
| | - Archana A Randale
- Department of Pathology, Superspeciality Hospital and Government Medical College, Nagpur, Maharashtra, India
| | - Waman K Raut
- Department of Pathology, Superspeciality Hospital and Government Medical College, Nagpur, Maharashtra, India
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Ha TS, Park CM, Yang JH, Cho YH, Chung CR, Jeon K, Suh GY. Disseminated Gastrointestinal Mucormycosis in Immunocompromised Disease. Korean J Crit Care Med 2015. [DOI: 10.4266/kjccm.2015.30.4.323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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