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Published in: BMC Infectious Diseases 1/2024

Open Access 01-12-2024 | Liver Cirrhosis | Case Report

Mucormycosis mimicking portal hypertensive haemorrhage as a complication of alcoholic liver cirrhosis: a case report

Author: Ran Ji

Published in: BMC Infectious Diseases | Issue 1/2024

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Abstract

Mucor is a rare cause of gastrointestinal ulcers. This case describes a case of mucormycosis that occurred in a patient with liver cirrhosis who was hospitalized to accept a splenectomy for traumatic splenic rupture. During the perioperative period, the patient developed upper gastrointestinal bleeding(UGIB), which was diagnosed as mucormycosis-related gastric ulcer according to gastroscopy. Patients with liver cirrhosis often get UGIB for Portal hypertension, but they also can develop UGIB for multiple other reasons, including infectious ulcers for immunosuppression. The case emphasizes the importance of excluding fungal-induced ulcer haemorrhage before diagnosing Portal hypertensive-induced variceal haemorrhage in patients with liver cirrhosis.
Literature
1.
go back to reference Cornely OA, Alastruey-Izquierdo A, Arenz D, Chen SCA, Dannaoui E, Hochhegger B, Hoenigl M, Jensen HE, Lagrou K, Lewis RE, et al. Global guideline for the diagnosis and management of mucormycosis: an initiative of the european Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium. Lancet Infect Dis. 2019;19(12):e405–21.CrossRefPubMedPubMedCentral Cornely OA, Alastruey-Izquierdo A, Arenz D, Chen SCA, Dannaoui E, Hochhegger B, Hoenigl M, Jensen HE, Lagrou K, Lewis RE, et al. Global guideline for the diagnosis and management of mucormycosis: an initiative of the european Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium. Lancet Infect Dis. 2019;19(12):e405–21.CrossRefPubMedPubMedCentral
2.
go back to reference Vaughan C, Bartolo A, Vallabh N, Leong SC. A meta-analysis of survival factors in rhino-orbital-cerebral mucormycosis-has anything changed in the past 20 years? Clin Otolaryngol. 2018;43(6):1454–64.CrossRefPubMed Vaughan C, Bartolo A, Vallabh N, Leong SC. A meta-analysis of survival factors in rhino-orbital-cerebral mucormycosis-has anything changed in the past 20 years? Clin Otolaryngol. 2018;43(6):1454–64.CrossRefPubMed
3.
go back to reference Prakash H, Ghosh AK, Rudramurthy SM, Singh P, Xess I, Savio J, Pamidimukkala U, Jillwin J, Varma S, Das A, et al. A prospective multicenter study on mucormycosis in India: epidemiology, diagnosis, and treatment. Med Mycol. 2019;57(4):395–402.CrossRefPubMed Prakash H, Ghosh AK, Rudramurthy SM, Singh P, Xess I, Savio J, Pamidimukkala U, Jillwin J, Varma S, Das A, et al. A prospective multicenter study on mucormycosis in India: epidemiology, diagnosis, and treatment. Med Mycol. 2019;57(4):395–402.CrossRefPubMed
4.
go back to reference Reid G, Lynch JP, Fishbein MC, Clark NM. Mucormycosis.Semin Respir Crit Care Med2020, 41(1). Reid G, Lynch JP, Fishbein MC, Clark NM. Mucormycosis.Semin Respir Crit Care Med2020, 41(1).
5.
go back to reference Metussin D, Telisinghe PU, Chong PL, Chong VH. Gastrointestinal: gastric mucormycosis. J Gastroenterol Hepatol. 2017;32(9):1537.CrossRefPubMed Metussin D, Telisinghe PU, Chong PL, Chong VH. Gastrointestinal: gastric mucormycosis. J Gastroenterol Hepatol. 2017;32(9):1537.CrossRefPubMed
6.
go back to reference Roden MM, Zaoutis TE, Buchanan WL, Knudsen TA, Sarkisova TA, Schaufele RL, Sein M, Sein T, Chiou CC, Chu JH, et al. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis. 2005;41(5):634–53.CrossRefPubMed Roden MM, Zaoutis TE, Buchanan WL, Knudsen TA, Sarkisova TA, Schaufele RL, Sein M, Sein T, Chiou CC, Chu JH, et al. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis. 2005;41(5):634–53.CrossRefPubMed
7.
go back to reference Spellberg B. Gastrointestinal mucormycosis: an evolving disease. Gastroenterol Hepatol (N Y). 2012;8(2):140–2.PubMed Spellberg B. Gastrointestinal mucormycosis: an evolving disease. Gastroenterol Hepatol (N Y). 2012;8(2):140–2.PubMed
8.
go back to reference Kumar C, Jain P, Wadhwa N, Diwaker P, Nirupma Panikar K. Nosocomial Jejunal Mucormycosis - an unusual cause of Perforation Peritonitis. Iran J Pathol. 2017;12(3):295–300.CrossRefPubMedPubMedCentral Kumar C, Jain P, Wadhwa N, Diwaker P, Nirupma Panikar K. Nosocomial Jejunal Mucormycosis - an unusual cause of Perforation Peritonitis. Iran J Pathol. 2017;12(3):295–300.CrossRefPubMedPubMedCentral
9.
go back to reference Weichselbaum L, Azouz A, Smolen KK, Das J, Splittgerber M, Lepida A, Moreno C, Schreiber J, Sersté T, Trepo E, et al. Epigenetic basis for monocyte dysfunction in patients with severe alcoholic hepatitis. J Hepatol. 2020;73(2):303–14.CrossRefPubMed Weichselbaum L, Azouz A, Smolen KK, Das J, Splittgerber M, Lepida A, Moreno C, Schreiber J, Sersté T, Trepo E, et al. Epigenetic basis for monocyte dysfunction in patients with severe alcoholic hepatitis. J Hepatol. 2020;73(2):303–14.CrossRefPubMed
11.
go back to reference Haque H, Nettboy S, Kumar S. Surgical-site mucormycosis infection in a solid-organ transplant recipient and a concise review of the literature.BMJ Case Rep2019, 12(12). Haque H, Nettboy S, Kumar S. Surgical-site mucormycosis infection in a solid-organ transplant recipient and a concise review of the literature.BMJ Case Rep2019, 12(12).
12.
go back to reference Menezes S, Kumar JS, Rudra OS, Nagral A. Cutaneous mucormycosis: an unusual cause of decompensation in a patient with ethanol-related cirrhosis with COVID-19 exposure.BMJ Case Rep2022, 15(2). Menezes S, Kumar JS, Rudra OS, Nagral A. Cutaneous mucormycosis: an unusual cause of decompensation in a patient with ethanol-related cirrhosis with COVID-19 exposure.BMJ Case Rep2022, 15(2).
13.
go back to reference Ghaderkhani S, Ahmadinejad Z, Dashti H, Safaei M, Ghiasvand F. Wound Infection with an Unusual Pathogen after Liver Transplantation. Case Rep Transplant 2020, 2020:8396507. Ghaderkhani S, Ahmadinejad Z, Dashti H, Safaei M, Ghiasvand F. Wound Infection with an Unusual Pathogen after Liver Transplantation. Case Rep Transplant 2020, 2020:8396507.
14.
go back to reference Ginès P, Krag A, Abraldes JG, Solà E, Fabrellas N, Kamath PS. Liver cirrhosis. Lancet (London England). 2021;398(10308):1359–76.CrossRefPubMed Ginès P, Krag A, Abraldes JG, Solà E, Fabrellas N, Kamath PS. Liver cirrhosis. Lancet (London England). 2021;398(10308):1359–76.CrossRefPubMed
15.
go back to reference Simpson KJ, Chalmers N, Redhead DN, Finlayson ND, Bouchier IA, Hayes PC. Transjugular intrahepatic portasystemic stent shunting for control of acute and recurrent upper gastrointestinal haemorrhage related to portal hypertension. Gut. 1993;34(7):968–73.CrossRefPubMedPubMedCentral Simpson KJ, Chalmers N, Redhead DN, Finlayson ND, Bouchier IA, Hayes PC. Transjugular intrahepatic portasystemic stent shunting for control of acute and recurrent upper gastrointestinal haemorrhage related to portal hypertension. Gut. 1993;34(7):968–73.CrossRefPubMedPubMedCentral
16.
go back to reference Mitchell CJ, Jewell DP. The diagnosis of the site of upper gastrointestinal haemorrhage in patients with established portal hypertension. Endoscopy. 1977;9(3):131–5.CrossRefPubMed Mitchell CJ, Jewell DP. The diagnosis of the site of upper gastrointestinal haemorrhage in patients with established portal hypertension. Endoscopy. 1977;9(3):131–5.CrossRefPubMed
17.
go back to reference Lo G-H, Reiberger T. Peptic ulcer bleeding in patients with cirrhosis: is it as bad as variceal bleeding? Hepatology (Baltimore MD). 2018;67(4):1219–20.CrossRefPubMed Lo G-H, Reiberger T. Peptic ulcer bleeding in patients with cirrhosis: is it as bad as variceal bleeding? Hepatology (Baltimore MD). 2018;67(4):1219–20.CrossRefPubMed
18.
go back to reference Hsu Y-C, Lin J-T, Chen T-T, Wu M-S, Wu C-Y. Long-term risk of recurrent peptic ulcer bleeding in patients with liver cirrhosis: a 10-year nationwide cohort study. Hepatology (Baltimore MD). 2012;56(2):698–705.CrossRefPubMed Hsu Y-C, Lin J-T, Chen T-T, Wu M-S, Wu C-Y. Long-term risk of recurrent peptic ulcer bleeding in patients with liver cirrhosis: a 10-year nationwide cohort study. Hepatology (Baltimore MD). 2012;56(2):698–705.CrossRefPubMed
19.
go back to reference Jeong W, Keighley C, Wolfe R, Lee WL, Slavin MA, Kong DCM, Chen SCA. The epidemiology and clinical manifestations of mucormycosis: a systematic review and meta-analysis of case reports. Clin Microbiol Infect. 2019;25(1):26–34.CrossRefPubMed Jeong W, Keighley C, Wolfe R, Lee WL, Slavin MA, Kong DCM, Chen SCA. The epidemiology and clinical manifestations of mucormycosis: a systematic review and meta-analysis of case reports. Clin Microbiol Infect. 2019;25(1):26–34.CrossRefPubMed
20.
go back to reference Kim A, Wu X, Allende DS, Nagy LE. Gene Deconvolution Reveals Aberrant Liver Regeneration and Immune Cell Infiltration in Alcohol-Associated Hepatitis.Hepatology (Baltimore, Md)2021, 74(2). Kim A, Wu X, Allende DS, Nagy LE. Gene Deconvolution Reveals Aberrant Liver Regeneration and Immune Cell Infiltration in Alcohol-Associated Hepatitis.Hepatology (Baltimore, Md)2021, 74(2).
21.
go back to reference Lee SH, Son YG, Sohn SS, Ryu SW. Successful treatment of invasive gastric mucormycosis in a patient with alcoholic liver cirrhosis: a case report. Experimental and Therapeutic Medicine. 2014;8(2):401–4.CrossRefPubMedPubMedCentral Lee SH, Son YG, Sohn SS, Ryu SW. Successful treatment of invasive gastric mucormycosis in a patient with alcoholic liver cirrhosis: a case report. Experimental and Therapeutic Medicine. 2014;8(2):401–4.CrossRefPubMedPubMedCentral
23.
go back to reference Izbéki F, Kiss I, Wittmann T, Várkonyi TT, Légrády P, Lonovics J. Impaired accommodation of proximal stomach in patients with alcoholic liver cirrhosis. Scand J Gastroenterol. 2002;37(12):1403–10.CrossRefPubMed Izbéki F, Kiss I, Wittmann T, Várkonyi TT, Légrády P, Lonovics J. Impaired accommodation of proximal stomach in patients with alcoholic liver cirrhosis. Scand J Gastroenterol. 2002;37(12):1403–10.CrossRefPubMed
24.
go back to reference Aqel BA, Scolapio JS, Dickson RC, Burton DD, Bouras EP. Contribution of ascites to impaired gastric function and nutritional intake in patients with cirrhosis and ascites. Clin Gastroenterol Hepatol. 2005;3(11):1095–100.CrossRefPubMed Aqel BA, Scolapio JS, Dickson RC, Burton DD, Bouras EP. Contribution of ascites to impaired gastric function and nutritional intake in patients with cirrhosis and ascites. Clin Gastroenterol Hepatol. 2005;3(11):1095–100.CrossRefPubMed
25.
go back to reference Moghadamrad S, Hassan M, McCoy KD, Kirundi J, Kellmann P, De Gottardi A. Attenuated fibrosis in specific pathogen-free microbiota in experimental cholestasis- and toxin-induced liver injury. FASEB Journal: Official Publication of the Federation of American Societies For Experimental Biology. 2019;33(11):12464–76.CrossRefPubMed Moghadamrad S, Hassan M, McCoy KD, Kirundi J, Kellmann P, De Gottardi A. Attenuated fibrosis in specific pathogen-free microbiota in experimental cholestasis- and toxin-induced liver injury. FASEB Journal: Official Publication of the Federation of American Societies For Experimental Biology. 2019;33(11):12464–76.CrossRefPubMed
26.
go back to reference Lyles T, Elliott A, Rockey DC. A risk scoring system to predict in-hospital mortality in patients with cirrhosis presenting with upper gastrointestinal bleeding. J Clin Gastroenterol. 2014;48(8):712–20.CrossRefPubMed Lyles T, Elliott A, Rockey DC. A risk scoring system to predict in-hospital mortality in patients with cirrhosis presenting with upper gastrointestinal bleeding. J Clin Gastroenterol. 2014;48(8):712–20.CrossRefPubMed
27.
go back to reference Lu Z, Sun X, Han J, Jin B, Zhang W, Han J, Ma X, Liu B, Yu X, Wu Q, et al. Characteristics of peptic ulcer bleeding in cirrhotic patients with esophageal and gastric varices. Sci Rep. 2020;10(1):20068.CrossRefPubMedPubMedCentral Lu Z, Sun X, Han J, Jin B, Zhang W, Han J, Ma X, Liu B, Yu X, Wu Q, et al. Characteristics of peptic ulcer bleeding in cirrhotic patients with esophageal and gastric varices. Sci Rep. 2020;10(1):20068.CrossRefPubMedPubMedCentral
Metadata
Title
Mucormycosis mimicking portal hypertensive haemorrhage as a complication of alcoholic liver cirrhosis: a case report
Author
Ran Ji
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2024
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-023-08220-0

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