Valentino's syndrome with secondary appendiceal perforation and fungal involvement

Valentino's syndrome (VS) is a rare presentation of perforated peptic ulcer disease causing right lower quadrant (RLQ) pain mimicking acute appendicitis. Secondary appendiceal perforation with fungal colonization is exceptionally uncommon. A 65-year-old woman presented with worsening RLQ pain, nausea, vomiting, diffuse peritoneal irritation, McBurney tenderness, and hemodynamic instability. Contrast-enhanced computed tomography demonstrated pneumoperitoneum, a pre-pyloric gastric wall defect, and periappendiceal inflammation suggestive of VS. Exploratory laparotomy confirmed generalized peritonitis from pre-pyloric gastric perforation with contamination tracking along the right paracolic gutter. A retrocecal appendix with secondary tip perforation further obscured the diagnosis. Appendectomy and primary gastric repair were performed. Histopathology showed extensive necrosis and fungal hyphae morphologically consistent with Aspergillus spp. on Grocott-Gomori methenamine silver staining, interpreted as secondary fungal involvement. This case broadens the clinical spectrum of VS and highlights careful histopathological interpretation in severely necrotic tissue.