Neonatal Med.  2017 Aug;24(3):134-139. 10.5385/nm.2017.24.3.134.

Gastrointestinal Mucormycosis in Extremely Low Birth Weight Infants Mimicking Atypical Necrotizing Enterocolitis and Intussusception

• Jun H
• Lee DH
• Song YH
• Yoon JM
• Cheon EJ
• Ko KO
• Park SM
• Lim JW

• KMID: 2388978
• DOI: http://doi.org/10.5385/nm.2017.24.3.134

Abstract

Neonatal gastrointestinal mucormycosis, a rare disease with a high mortality rate, shows a rapid progressive course in premature infants with an immature immune system. We report the case of a male neonate weighing 970 g, delivered via cesarean section at 27 weeks, as one of a pair of dizygotic twins. From the 7(th) day after birth, bile was seen to drain through the orogastric tube, and paralytic ileus was noted on performing an abdominal X-ray. Thus, oral feeding was discontinued because necrotizing enterocolitis (NEC) was highly suspected. On the 9(th) day after birth, a firm mass was palpable in left upper abdominal quadrant, but no pneumatosis intestinalis was observed on performing abdominal X-ray. Small bowel intussusception was suspected on performing abdominal ultrasonography. Based on these findings, an exploratory laparotomy was performed, and although no intussusception was found intraoperatively, we performed a partial gastrectomy and hemicolectomy due to the presence of necrotic changes and perforations of the stomach and colon. Postoperatively, he was observed to have hypotension with persistence of hemorrhage at the surgical site. He died on the 11(th) day after birth. Intraoperative histopathological examination of stomach and colon showed fungal aseptate hyphae with broad branching. Gastrointestinal mucormycosis was confirmed based on findings of vascular involvement in the form of fungal hyphae and thrombosis in the transmural blood vessels. We report a case of an extremely low birth weight infant with neonatal gastrointestinal mucormycosis with an initial clinical presentation suggestive of intussusception and atypical NEC.

Keyword

Mucormycosis; Necrotizing enterocolitis; Intussusception; Low birth weight infant; Candida; Fungi

MeSH Terms

Bile
Blood Vessels
Candida
Cesarean Section
Colon
Enterocolitis, Necrotizing*
Female
Fungi
Gastrectomy
Hemorrhage
Humans
Hyphae
Hypotension
Immune System
Infant*
Infant, Extremely Low Birth Weight
Infant, Low Birth Weight*
Infant, Newborn
Infant, Premature
Intestinal Pseudo-Obstruction
Intussusception*
Laparotomy
Male
Mortality
Mucormycosis*
Parturition
Pregnancy
Rare Diseases
Stomach
Thrombosis
Twins, Dizygotic
Ultrasonography