Gastrointestinal Mucormycosis Initially Manifest as Hematochezia from Arterio-Enteric Fistula

Excerpt

A 41-year-old man was evaluated in the emergency department for acute hematochezia accompanied by hemorrhagic shock. Ten months prior to presentation, he had received a hematopoietic stem cell transplant from an HLA-matched, related donor for Philadelphia chromosome-positive B cell acute lymphoblastic leukemia (ALL). He also had a history of Stage III rectal cancer treated with neo-adjuvant chemoradiation (cetuximab/capecitibine), low anterior resection, and adjuvant chemotherapy (capecitabine/oxaliplatin) 5 years prior to transplantation. On presentation, there was no evidence of either malignancy. After stabilization with massive transfusion of blood products, computed tomography (CT) angiography of the abdomen and pelvis demonstrated an arterio-enteric fistula between the left common iliac artery and the sigmoid colon (Fig. 1). Interventional radiology (IR) emergently performed angiography followed by successful deployment of a left common iliac artery stent (Fig. 2).

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