Clin Endosc.  2020 Nov;53(6):746-749. 10.5946/ce.2020.180.

Rare and Fatal Gastrointestinal Mucormycosis (Zygomycosis) in a COVID-19 Patient: A Case Report

• Monte Junior ESd
• Santos MELd
• Ribeiro IB
• Luz GdO
• Baba ER
• Hirsch BS
• Funari MP
• de Moura EGH

• KMID: 2511236
• DOI: http://doi.org/10.5946/ce.2020.180

Abstract

The novel coronavirus disease (COVID-19) quickly spread to all continents. However, data regarding all the signs and symptoms of COVID-19 are insufficient. Patients with COVID-19 might present higher susceptibility to fungal coinfections. Mucormycosis is a rare and often life-threatening fungal disease characterized by vascular invasion by hyphae, resulting in thrombosis and necrosis. This is the first case report of mucormycosis in a COVID-19 patient. An 86-year-old male patient was admitted to the emergency room with acute diarrhea, cough, dyspnea, and fever from 5 days prior. Blood tests revealed a hemoglobin level of 14.3 mg/dL. Five days following the admission, the patient presented with melena and a hemoglobin level of 5.6 mg/dL. A transfusion of three units of red blood cells was required. Esophagogastroduodenoscopy revealed two giant gastric ulcers with necrotic debris and a deep hemorrhagic base without active bleeding. Furthermore, biopsies confirmed mucormycosis. Despite intensive care, the patient died 36 hours after the esophagogastroduodenoscopy.

Keyword

Coronavirus infections; Gastroenteritis; Gastrointestinal hemorrhage; Mucormycosis; Zygomycosis

Figure

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  Fig. 1. The chest computed tomography revealed ground-glass opacity with consolidative abnormalities.

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  Fig. 2. The esophagogastroduodenoscopy demonstrated a giant ulcer in (A) the greater curvature, (B) fundus, and (C) antrum.

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  Fig. 3. (A) The gastric border and base with necrotic fibrinoid debris. The fungus structures are visible at a low-power view (arrows). Hematoxylin and eosin staining, original magnification ×100. (B) Presence of broad, irregular, non-septate hyphae of mucormycosis (arrows). Hematoxylin and eosin staining, original magnification ×400. (C) Hyphae stained with periodic acid-Schiff stain (arrow), original magnification ×400. (D) Note the hyphae with typical 90-degree angle branching (arrow). Grocott’s methenamine staining, original magnification ×400.

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