Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Infect Dis. Feb 25, 2018; 8(1): 1-3
Published online Feb 25, 2018. doi: 10.5495/wjcid.v8.i1.1
Gastric mucormycosis: A case report
Mpho Klaas Kgomo, Ali Ahmed Elnagar, Kgataki Mashoshoe, P Thomas, W G Van Hougenhouck-Tulleken
Mpho Klaas Kgomo, Ali Ahmed Elnagar, Kgataki Mashoshoe, P Thomas, W G Van Hougenhouck-Tulleken, Department of Gastroenterology, University of Pretoria, Pretoria 0001, Gauteng Province, South Africa
Author contributions: Kgomo MK was involved in the write-up and submission of the case report, patient care and interpretation of the literature; Elnagar AA, Mashoshoe K, Thomas P and Van Hougenhouck-Tulleken WG was involved in the collection of data, patient care and interpretation of test results.
Informed consent statement: The patient involved in this study gave her written informed consent authorizing use and disclosure of her protected health information.
Conflict-of-interest statement: Dr. Kgomo has nothing to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Mpho Klaas Kgomo, Professor, Department of Gastroenterology, University of Pretoria, Bophelo Street, Gezina, Pretoria 0001, Gauteng Province, South Africa.
Telephone: +27-12-3542246 Fax: +27-12-3220696
Received: September 14, 2017
Peer-review started: September 16, 2017
First decision: October 23, 2017
Revised: November 9, 2017
Accepted: November 27, 2017
Article in press: November 27, 2017
Published online: February 25, 2018

Mucormycosis is a rare fungal infection which is largely diagnosed in immune-compromised patients. The infection can cause pulmonary, rhinocerebral, skin and soft tissue, central nervous system and gastrointestinal system. The gastrointestinal involvement is the rarest presentation, especially the stomach. We present a 38 years old HIV positive female seen in Steve Biko Academic Hospital with 2 wk history of cough, shortness of breath and lethargy. She was clinically found to be pale, pyrexial, dyspnoea and had severe oral thrush. Blood tests revealed hemoglobin of 6 g/dL CD4 count of 63 cells/uL. Chest X-ray showed multi-lobe pneumonia and gastroscopy confirmed esophageal candidiasis and nodular gastritis. She continued to deteriorate despite antibiotics, antifungal and antituberculous treatment. She developed upper gastrointestinal bleed on day 34, and gastroscopy showed a plaque like lesion in the stomach, histology of which confirmed mucormycosis. She improved on Amphotericin B but subsequently deteriorated and demised a few days later. These cases illustrate the occurrence of a rare fungal infection of the stomach and the poor mortality when diagnosis is delayed. Mucormycosis can co-exist with candidiasis and clinicians should have a high index of suspicion especially in patients not responding to appropriate treatment.

Keywords: Gastric, Mucormycosis, Human deficiency virus, Candidiasis, Amphotericin B, Diflucan, Pneumonia, Tuberculosis, Gastrointestinal bleed

Core tip: Gastric mucormycosis is very rare; co-infection with candida albicans is even more rare. Candidiasis masked the presence of mucormycosis in this patient and was suspected because of poor response to diflucan. Treatment with amphotericin B was delayed but once instituted, the response was good. Awareness of this co-existence of mucormycosis and candida infection in immune-compromised patient should be improved.