Successful nonoperative management of gastrointestinal mucormycosis: novel therapy for invasive disease.
BACKGROUND
Invasive opportunistic fungal infections caused by agents of Mucorales that involve the gastrointestinal tract are uncommon but aggressive. These ubiquitous fungal spores typically are inhaled and can germinate in immunocompromised hosts. Standard therapy for invasive mucormycosis includes parenteral amphotericin B (AMB) in combination with radical debridement of infected tissues. Early diagnosis and treatment are of paramount importance. Unfortunately, long-term survival is poor owing to the prohibitive morbidity and mortality rates associated with the medical and surgical therapies. Posaconazole is a novel, extended-spectrum triazole oral antifungal agent with documented success in the treatment of patients with invasive mucormycosis.


METHODS
Case report and literature review.


RESULTS
A 50-year-old man presented with invasive mucormycosis of the lower esophagus, stomach, and liver, resulting in gastrointestinal hemorrhage. The infection did not respond to AMB but was treated successfully with a combination of posaconazole and liposomal AMB (LAMB) without surgical debridement.


CONCLUSIONS
To our knowledge, this is the first reported case of extensive gastric and intrahepatic mucormycosis that responded to combination posaconazole and LAMB without surgical debridement. This approach may be an alternative to surgery in patients who are precluded from extensive surgical intervention.
Mezhir
James J
JJ
Department of Surgery, Section of General Surgery, University of Chicago, Chicago, Illinois 60637, USA.
Mullane
Kathleen M
KM
Zarling
Joel
J
Satoskar
Rohit
R
Pai
Rish K
RK
Roggin
Kevin K
KK
D000666:Amphotericin B / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005767:Gastrointestinal Diseases / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009089:Mucor / Q000187:drug effects*; D009091:Mucormycosis / Q000188:drug therapy* / Q000382:microbiology; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use*
D000935:Antifungal Agents; D014230:Triazoles; C068538:liposomal amphotericin B; C101425:posaconazole; D000666:Amphotericin B