Gastrointestinal mucormycosis in the pediatric age group: an evolving disease

BACKGROUND

Mucormycosis is a devastating opportunistic fungal infection resulting in significant mortality, especially in pediatric patients with predisposing risk factors.

MATERIALS & METHODS

Biopsies and surgical specimens reported and proven as Mucormycosis in children under 12 years of age were retrieved from the records for three years (January 2018 to January 2021). Complete data, predisposing factors, treatment, and clinical outcome were recorded.

RESULTS

15 cases were identified, ranging from 9 days to 5 years. The male-female ratio was 3:1; three children were preterm. Fourteen children were diagnosed with gastrointestinal Mucormycosis (14/15), and one had palatal and sinusoidal involvement. Abdominal pain with distention was the most typical complaint. On microscopy, biopsies and surgical specimens showed extensive liquefactive necrosis with broad aseptate fungal hyphae. An intraoperative diagnosis was rendered in two cases. All neonates underwent exploratory laparotomy with surgical debridement and were administered Liposomal Amphotericin B. However, only two neonates survived out of the fifteen cases, one with disease limited to the appendix and pouch colon. The others succumbed to the disease despite antifungal therapy and surgical debridement. Thus, the overall mortality in the current study was calculated to be 86%, with neonatal mortality of 75%.

CONCLUSION

Gastrointestinal involvement is more common in neonates and infants with a male preponderance. The diagnosis relies on direct microscopy, histopathology, and fungal culture. Intraoperative tissue may be sent in all suspected cases for direct microscopic examination for rapid diagnosis and treatment.

Colorectal cancer in children: case report and review of literature

Compared to adults, colorectal carcinoma is rare in children and has poorer prognosis, due to delay in diagnosis, advanced stage at presentation and aggressive natural history. We describe a case of mucinous adenocarcinoma of the rectum in a eleven year old boy and review the literature regarding colorectal cancer in children. A high index of suspicion and an early diagnosis may lead to an improvement in the dismal prognosis of this disease in children.