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Successful medical treatment of intestinal ulceration caused by Rhizopus microsporus

Bone Marrow Transplantation volume 32, pages 739–740 (2003)Cite this article

Candida species are the most common fungi isolated after hematopoietic cell transplant, but molds are now emerging as opportunistic pathogens with a poor prognosis.1,2 We present a case of Rhizopus infection presenting as recurrent bleeding from necrotic ulcers in the small intestine, ultimately cured by antifungal therapy.

Mucormycosis is the common name given to several different diseases caused by fungi of the class Zygomycetes, order Mucorales. Of this order, the family Mucoraceae is the most common intestinal mold infection (78 cases have been reported to date) and Rhizopus is the most commonly isolated genus.1 The spectrum of gastrointestinal tract involvement with molds includes colonization, mucosal infiltration, and vascular invasion.3 Rhizopus microsporus is prone to invade blood vessels producing vasculitis, thrombosis, and ischemic necrosis – features that distinguish tissue invasion from mere colonization.3,4 A large ulcer with black necrotic tissue, hardness of the surrounding tissues, and sharply demarcated edges is the usual macroscopic appearance seen at endoscopy or surgery.5 Perforation may also occur. We speculate that the size and focal nature of the ulcers in our case represent a relatively early stage of invasive Rhizopus infection.

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Acknowledgements

Supported by grants from the National Institutes of Health (CA 15704 and CA 18029). Dr Pinto-Marques was sponsored by the FundacĂŁo Luso-Americana para and Desenvolvimento and Hospital Garcia de Orta, Portugal.

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  1. D Tapper: Deceased.

Authors and Affiliations

  1. Gastroenterology/Hepatology, Fred Hutchinson Cancer Research Center, University of Washington School of Medicine, Seattle, Washington, USA

    P Pinto-Marques, D M Hockenbery & G B McDonald

  2. Pathology Section, Fred Hutchinson Cancer Research Center, University of Washington School of Medicine, Seattle, Washington, USA

    R C Hackman

  3. Department of Surgery, Childrens’ Hospital and Regional Medical Center, and the University of Washington School of Medicine, Seattle, Washington, USA

    D Tapper

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  1. P Pinto-Marques
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  2. D M Hockenbery
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  4. D Tapper
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  5. G B McDonald
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Pinto-Marques, P., Hockenbery, D., Hackman, R. et al. Successful medical treatment of intestinal ulceration caused by Rhizopus microsporus. Bone Marrow Transplant 32, 739–740 (2003). https://doi.org/10.1038/sj.bmt.1704217

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