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\title{Jejunal mucormycosis in a patient with refractory AML}



\author[1]{Samuel De l'Etoile-Morel}%
\author[1]{Vladimir Sapon-Cousineau}%
\author[1]{Michael Sebag}%
\author[1]{Zu-hua Gao}%
\author[1]{Dan Deckelbaum}%
\author[1]{Vivian Loo}%
\affil[1]{McGill University Health Centre}%


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  \date{June 12, 2024}


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Jejunal mucormycosis in a patient with refractory AML

Samuel De l'Etoile-Morel, MD. McGill University Health Centre.
Department of Medicine, Division of Infectious Diseases. 1001 Decarie
Blvd, Montreal, Quebec H4A 3J1 Room E05.1811.2.

Vladimir Sapon-Cousineau, MD. Department of Medicine, Division of
Hematology. 1001 Decarie Blvd, Montreal, Quebec H4A 3J1 Room D02.7731.

Dan L. Deckelbaum, MD. McGill University Health Centre. Department of
Surgery, Divisions of Trauma and General Surgery. 1650 Cedar Ave,
Montreal, Quebec H3G 1A4. L9 425.

Michael Sebag, MD McGill University Health Centre. Department of
Medicine, Division of Hematology. 1001 Decarie Blvd, Montreal, Quebec
H4A 3J1 Room D02.7515.

Zu-hua Gao, MD McGill University Health Centre. Department of Clinical
Laboratory Medicine, Division of Pathology. 1001 Decarie Blvd, Montreal,
Quebec H4A 3J1 Room E04.1820.

Vivian G. Loo, MD McGill University Health Centre. Department of
Medicine, Division of Infectious Diseases. 1001 Decarie Blvd, Montreal,
Quebec H4A 3J1 Room E05.1824.

Corresponding author : Samuel De l'Etoile-Morel, MD. McGill University
Health Centre. Department of Medicine, Division of Infectious Diseases.
1001 Decarie Blvd, Montreal, Quebec H4A 3J1 Room E05.1811.2. Telephone
514-934-1934 extension 53333 samuel.deletoile-morel@mail.mcgill.ca

A 47-year-old man received chemotherapy for the treatment of refractory
acute myeloid leukemia. Two weeks after re-induction, he developed
fever, neutropenia, nausea and severe vomiting with abdominal pain.
Computed tomography of the abdomen showed a small bowel obstruction with
ischemic changes of the jejunum concerning for mesenteric ischemia
(panel A). An urgent open laparotomy was performed revealing two areas
of jejunal necrosis (panel B) and the patient underwent a partial small
bowel resection with primary anastomosis.

Histopathological examination of the jejunum with Grocott staining
demonstrated ischemic necrosis associated with angioinvasive zygomycosis
(panel C). \emph{Rhizopus oryzae} was identified as the causative
pathogen using polymerase chain reaction followed by DNA sequence
analysis on the pathology specimen.

The patient was treated intravenously with liposomal amphotericin and
subsequently transitioned to oral isavuconazole. He was subsequently
discharged from the hospital and died approximately 1 year later of
progressive AML.

Gastrointestinal mucormycosis remains a rare infection among
immunocompromised hosts and a high index of suspicion is imperative (1).
Its presentation can mimic ischemic colitis often resulting in a
diagnosis made by pathology and not by conventional culture. Successful
management includes early surgical resection and initiation of
appropriate antifungal therapy.

1. Spellberg B. Gastrointestinal mucormycosis: an evolving disease.
Gastroenterol Hepatol (N Y). 2012;8(2):140-2.

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