Nosocomial Jejunal Mucormycosis - an Unusual Cause of Perforation Peritonitis

Document Type: Case Reports

Authors

1 Dept. of Pathology, University College of Medical Sciences, University of Delhi, Delhi, India

2 Dept. of Pathology, Guru Teg Bahadur Hospital, Shahdra, Delhi, India

Abstract

Mucormycosis is a rare but highly invasive opportunistic fungal infection. Gastrointestinal disease although uncommon is highly fatal. We report a case of jejunal mucormycosis in a 24 year old undernourished female with preceding surgical intervention for acute intestinal obstruction of tubercular etiology. On 8th post-operative day, she developed oozing from suture line, prompting exploratory laparotomy, bowel resection, jejunostomy and ileal mucus fistula. Resected bowel showed one perforation and several areas of impending perforations. Characteristic broad, pauci-septate hyaline, empty looking hyphae with infrequent branching were found transmurally and showing angio-invasion. Local intestinal tissue trauma coupled with her sub-normal immune status permitted this unusual nosocomial infection. Histopathologic demonstration of the fungus in surgical specimens remains cornerstone of diagnosis of mucormycosis in view of its non-specific symptoms, low isolation rates of mycologic culture and lack of other rapid tests. 

Highlights

  • Mucormycosis of jejunum is rare, but mucosal injury is a known predisposing factor.
  • Mycolgic angioinvasion is responsible for bowel perforation.
  • Histopathology demonstrates characteristic wide fungal hyphae with non-parallel sides.

Keywords

Main Subjects


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