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Case report
Diagnosis of oesophageal mucormycosis managed with medical therapy alone
  1. Matthew Ringer1,
  2. Lauren Pischel2 and
  3. Marwan Mikheal Azar3
  1. 1Internal Medicine, Yale New Haven Health System, New Haven, Connecticut, USA
  2. 2Department of Internal Medicine, Section of Infectious Disease, Yale New Haven Health System, New Haven, Connecticut, USA
  3. 3Yale University School of Medicine, Yale New Haven Health System, New Haven, Connecticut, USA
  1. Correspondence to Dr Matthew Ringer; matthew.ringer{at}yale.edu

Abstract

Mucormycosis is an invasive mould that can cause aggressive infection, particularly in immunocompromised patients. Though oesophageal mucormycosis is relatively rare, it remains an elusive and devastating manifestation of this disease. The management is also challenging, due to surgical morbidity and contraindications such as thrombocytopenia in immunocompromised hosts. In this report, we present the case of a 60-year-old Lebanese man with newly diagnosed acute myeloid leukaemia who developed oesophageal mucormycosis after induction chemotherapy with idarubicin/cytarabine (7+3). The diagnosis was made when the patient developed febrile neutropenia and odynophagia. CT scan of the chest revealed a thickened oesophagus. Oesophagogastroduodenoscopy with biopsy, histopathology and PCR were performed, resulting in the diagnosis of Rhizopus microsporus. The patient was successfully treated with liposomal amphotericin B and salvage posaconazole therapy without surgical intervention. We reviewed the clinical characteristics of the six published oesophageal mucormycosis reports from the literature.

  • infectious diseases
  • infections
  • infection (gastroenterology)
  • haematology (incl blood transfusion)

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Footnotes

  • Contributors Conception, planning and design, acquisition of data or analysis and interpretation of data: MR, LP and MMA. Drafting the article or revising it critically for important intellectual content: MR, LP and MMA. Final approval of the version published: MR, LP and MMA. Agreement to be accountable for the article and to ensure that all questions regarding the accuracy or integrity of the article are investigated and resolved: MR, LP and MMA.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer-reviewed.