Gastrointestinal Mucormycosis in the Setting of Colonic Pseudo-Obstruction

Mucormycosis is a rare opportunistic infection caused by the fungi order Mucorales that can affect multiple different organ systems. A 49-year-old man with a history of poorly controlled diabetes and hypertension presented with acute-on-chronic abdominal pain with profound worsening in the past 24 hours. He was found to have chronic intestinal pseudo-obstruction, with pneumatosis of the transverse colonic wall requiring total abdominal colectomy. Within two weeks after surgery, he developed fundal gastric injury with herniation requiring primary repair with surgical laparotomy. Tissue histopathology post-procedure revealed broad and irregular fungal hyphae, revealed to be Rhizopus microsporus on broad-spectrum PCR. Gastrointestinal mucormycosis is an emerging invasive fungal disease, often diagnosed post-mortem due to high mortality rates. Risk factors include noncommunicable chronic diseases such as diabetes and malignancy, as well as communicable diseases, including COVID-19. Surgical debridement is key to improving outcomes, as infection tends to cross tissue planes without adequate source control.