Mucormycosis in Patients with Inflammatory Bowel Disease: Case Series and Review of the Literature

Table 1

Summary of cases of invasive mucormycosis in patients with inflammatory bowel disease described in the literature.

	Case  1	Case  2	Case  3	Case  4	Case  5	Case  6	Case  7
Age (y)/sex	68/M	52/F	41/F	37/M	32/M	59/F	60/M
Risk factor	Ulcerative colitis; diabetes mellitus	Crohn’s disease	Crohn’s disease; diabetes mellitus; (well controlled)	Ulcerative colitis	Crohn’s disease	Ulcerative colitis status posttotal colectomy 20 y prior to admission.	Inflammatory bowel disease
Treatment for IBD	Chronic corticosteroids		Azathioprine and infliximab	Corticosteroids, mesalazine	Infliximab infusions, oral 6 mercaptopurine (6 MP), and oral and intravenous corticosteroids	Methotrexate, corticosteroids	Intravenous corticosteroids, oral 6-MP, and oral sulfasalazine
Initial symptoms	Fever, cough, and chest pain. Nonresolving pneumonia	Peritonitis followed by intestinal perforation	Nasal congestion, fullness, headache, and fevers	Exacerbation of underlying condition.; In-hospital course: fever, septic shock, trans esophageal echocardiogram: 6 × 1.8 cm right atrial mass	Severe abdominal pain.; CT scan abdomen and pelvis: recurrent; pneumoperitoneum	Nonhealing periosteal lesion resembling pyoderma gangrenosum	High fever, nausea, vomiting, bloody diarrhea, and pain in right flank
Presentation form; of mucormycosis	Pulmonary; Bronchoscopy: soft tissue mass obstructing the bronchus intermedius suggestive of fungal pneumonia	Gastrointestinal	Sinus	Endocarditis; suspected hematogenous spread to lungs with multiple nodal lesions with central necrosis on chest computed tomography (CT)	Gastric perforation	Cutaneous	Disseminated; (colon and right kidney)
Diagnosis of mucormycosis	Antemortem; biopsy of bronchial mass: ulcerated bronchial wall with ischemic necrosis, fibrinopurulent exudates, and hyphae suggestive of mucormycosis	Postmortem: colon tissue: hyphae suggestive of Mucorales, cultures positive for Rhizopus microsporus; Peritoneal fluid: microscopic exam: broad irregular hyphae, culture: Rhizopus microsporus	Antemortem: sinus; biopsy: hyphae suggestive of Mucorales	Antemortem: histopathology of atrial endocardial vegetation showed mycotic hyphae.; Microbiologic cultures of atrial appendage positive for Mucor spp.	Antemortem: abdominal wall: histopathology: many broad based nonseptate hyphae admixed with necrotic tissue.	Antemortem: cutaneous; biopsy of new periosteal ulcer: hyphae suggestive of Rhizopus spp. on calcofluor white test.; Culture of periosteal ulcer grew Rhizopus spp.	Antemortem: right kidney: histopathology: large areas of necrosis. Blood vessel walls invaded by hyphae suggestive of Mucorales.; Culture of right kidney positive for Absidia corymbifera
Treatment	Pneumonectomy; Amphotericin B, caspofungin	Voriconazole	Surgical debridement and extensive facial tissue resection.; Amphotericin B for 30 days, 6 m course of posaconazole.	Excision of intracardiac mass.; Liposomal amphotericin B 5 mg/kg.	Surgical debridement, cholecystectomy.; Liposomal amphotericin B (abelcet) 350 mg IV daily	Surgery not done due to medical complications.; Liposomal amphotericin B (abelcet).; Followed by; oral itraconazole for 3 months.	Elective right nephrectomy, total colectomy.; Amphotericin B (0.7 mg/kg/d)
Outcome	Worsening of infection while on antifungals with spread to left upper lobe lung and pericardium.; Died	Died	Alive, off antifungals, and immune suppression	Alive, off antifungals,and immune suppression	Died	Alive, off antifungals, and immune suppression	Died
Year/reference	2012 [19]	2010 [14]	2009 [10]	2007 [17]	2007 [12]	2002 [16]	1997 [15]