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Gastrointestinal mucormycosis causing an acute abdomen in the immunocompromised pediatric patient--three cases
C Vadeboncoeur1, J M Walton, J Raisen
1Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada.
Abstract:
Mucormycosis is an infection caused by a ubiquitous fungus in immunocompromised individuals. Typically, it invades blood vessels, producing thrombosis and tissue infarction. This infection spans all pediatric age groups and can lead to hollow viscus perforation and bowel obstruction. A 30-month old male with large cell anaplastic lymphoma had a bowel obstruction. During emergency laparotomy, an ileoileal intussusception was identified, which required resection and anastomosis. In the pathological specimen, fungi of the Mucorales order were found to be associated with tissue necrosis. On the eighth day of life, a premature infant had abdominal distension secondary to bowel perforation. Partial gastric resection and multiple intestinal stomas were performed. Death occurred soon after, secondary to multiorgan failure. The autopsy and surgical specimens showed widespread mucormycosis. An adolescent had meningococcemia-induced septic shock. During recovery, hemorrhagic colitis developed, which led to perforation. The subtotal colectomy specimen showed widespread mucormycosis. The laparotomy findings are typical (black necrotic tissue involving the bowel), and when seen in the immunocompromised patient, should make one suspect gastrointestinal mucormycosis. Aggressive surgical debridement of devitalized tissue augmented by intravenous antifungal medication is the mainstay of treatment.
Insights
Gastrointestinal mucormycosis is a severe fungal infection affecting immunocompromised children, often leading to bowel obstruction or perforation. Early surgical intervention and antifungal treatment are crucial for survival.
Area of Science:
- Mycology
- Pediatric Infectious Diseases
- Gastroenterology
Background:
- Mucormycosis is a life-threatening fungal infection caused by the Mucorales order, prevalent in immunocompromised individuals.
- It commonly affects blood vessels, leading to thrombosis and tissue necrosis, and can manifest across all pediatric age groups.
- Gastrointestinal involvement presents serious complications such as hollow viscus perforation and bowel obstruction.
Observation:
- Case 1: A 30-month-old male with anaplastic lymphoma experienced a bowel obstruction due to ileoileal intussusception, with Mucorales fungi identified in necrotic tissue.
- Case 2: A premature infant developed bowel perforation and multiorgan failure, with autopsy revealing widespread mucormycosis.
- Case 3: An adolescent with meningococcemia developed hemorrhagic colitis and perforation, with subtotal colectomy specimens showing extensive mucormycosis.
Findings:
- Laparotomy findings of black, necrotic bowel tissue are characteristic of gastrointestinal mucormycosis in immunocompromised patients.
- The infection can rapidly progress, leading to severe complications and high mortality if not promptly addressed.
- Fungal elements of the Mucorales order were consistently identified in pathological and autopsy specimens.
Implications:
- Suspected gastrointestinal mucormycosis necessitates prompt diagnosis and aggressive management, including surgical debridement.
- Intravenous antifungal medication is a critical component of treatment alongside surgical intervention.
- Understanding the clinical presentations and diagnostic indicators is vital for improving outcomes in pediatric mucormycosis.