Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2019; 7(10): 1155-1160
Published online May 26, 2019. doi: 10.12998/wjcc.v7.i10.1155
F-18 fluorodeoxyglucose positron emission tomography/computed tomography image of gastric mucormycosis mimicking advanced gastric cancer: A case report
Bong-Il Song
Bong-Il Song, Department of Nuclear Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu 41932, South Korea
Author contributions: Song BI edited the all manuscript.
Supported by National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIP), No. 2017R1C1B5076640.
Institutional review board statement: This case report was reviewed and approved by the Institutional Review Board of Dongsan Medical Center Keimyung University (IRB No. 2018-04-021).
Informed consent statement: Informed consent was obtained from the patient.
Conflict-of-interest statement: Song BI declare no conflicts of interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Bong-Il Song, MD, Assistant Professor, Department of Nuclear Medicine, Dongsan Medical Center, Keimyung University School of Medicine, 56 Dalseong-ro, Jung-gu, Daegu 41931, South Korea. song@dsmc.or.kr
Telephone: +82-53-250-7023 Fax: +82-53-250-8695
Received: December 29, 2018
Peer-review started: December 29, 2018
First decision: March 10, 2019
Revised: March 21, 2019
Accepted: March 26, 2019
Article in press: March 26, 2019
Published online: May 26, 2019
Processing time: 148 Days and 18.4 Hours
Abstract
BACKGROUND

Mucormycosis is a very rare fungal infection, and its prognosis is poor. Most common sites of infection are the sinuses, lung, or skin, and gastric involvement is uncommon. The standard antifungal therapy is the treatment of choice for gastric mucormycosis. However, the symptoms of gastric mucormycosis are varied and the early diagnosis is not easy.

CASE SUMMARY

I report a 53-year-old alcoholic man, who was admitted due to epigastric pain. The upper gastrointestinal endoscopy revealed a huge ulcer lesion in the stomach, which was suspected to be gastric cancer. F-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) showed diffusely intense FDG uptake at the ulcer lesion of the stomach, and several enlarged hypermetabolic lymph nodes were noted at the left gastric chain. Although, endoscopy and F-18 FDG PET/CT findings suggested advanced gastric cancer with regional lymph node metastases, there was no cancer cells in the biopsy results and multiple fungal hyphae were noted in the periodic acid-Schiff stained image.

CONCLUSION

He was diagnosed with gastric mucormycosis and successfully underwent amphotericin B and posaconazole treatment.

Keywords: F-18 fluorodeoxyglucose; Positron emission tomography; Mucormycosis; Amphotericin B; Gastric cancer; Case report

Core tip: Gastric mucormycosis is very rare, and there have been no reports on the F-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) finding of gastric mucormycosis. Since, endoscopic findings of gastric mucormycosis reveal ulcer margin with inflammatory/necrotic debris and hemorrhagic clots, F-18 FDG PET/CT of gastric mucormycosis reveal increased FDG uptake in the infected site. Additionally, reactive enlarged hypermetabolic lymph nodes in the perigastric chain could be observed. In this regard, it was difficult to differentiate gastric mucormycosis and gastric cancer by endoscopic findings and radiologic examinations. Therefore, careful consideration of clinical manifestations and precise diagnosis are necessary for optimal treatment of gastric mucormycosis.