Infect Chemother.  2020 Mar;52(1):98-104. 10.3947/ic.2020.52.1.98.

Neutropenic Enterocolitis due to Mucormycosis in a Patient with Myelodysplastic Syndrome

• Park JW
• Chung JS
• Lee S
• Shin HJ

• KMID: 2507331
• DOI: http://doi.org/10.3947/ic.2020.52.1.98

Abstract

Neutropenic enterocolitis is a fatal enterocolitis occurring in neutropenic patients with immunocompromised diseases including hematologic malignancies. Gastrointestinal (GI) mucormycosis in hematologic malignancies has been rarely reported. Especially, in myelodysplastic syndrome (MDS), GI mucormycosis has never been reported. We report a case of GI mucormocysis manifesting as neutropenic enterocolitis in a patient with MDS.

Keyword

Gastrointestinal mucormycosis; Neutropenia; Myelodysplastic syndrome

Figure

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  Figure 1 Time course of antibiotics.

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  Figure 2 Abnormal wall thickening and decreased density of the ileocecal valve and terminal ileum, suggesting necrotizing enterocolitis (white arrows).

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  Figure 3 Perforation of the ileocecal valve (white arrows), terminal ileum with partial obstruction, and peritonitis.

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  Figure 4 Histological observations. (A) Microscopically extensive coagulative infarction of intestine was noticed and angioinvasion (arrow head) in the muscularis propria was identified (H&E, ×40). (B) Fungal hyphae were admixed with fibrinous material in the vascular lumen occluding the vasculature, which is referred to angioinvasion (H&E, ×200). (C) GMS staining demonstrated non-septated broad hyphae with right-angled branching, suggestive of invasive mucormycosis (GMS, ×200).H&E, hematoxylin and eosin; GMS, Gomori's methenamine silver.

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  Figure 5 Computed tomography abdominal scan showed perforation of terminal ileum at the ileocecal valve with gangrenous change and multifocal fluid collection in the peritoneum (white arrows).

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  Figure 6 Presence of (A) transmural infarction (H&E, ×40) with (B) fungal hyphae (Periodic acid-Schiff, ×400).H&E, hematoxylin and eosin.

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