Case Report
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World J Gastroenterol. Jun 14, 2013; 19(22): 3508-3511
Published online Jun 14, 2013. doi: 10.3748/wjg.v19.i22.3508
Colonic mucormycosis presented with ischemic colitis in a liver transplant recipient
Gi Won Do, Seok Won Jung, Jae-Bum Jun, Jae Hee Seo, Yang Won Nah
Gi Won Do, Seok Won Jung, Jae-Bum Jun, Department of Internal Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Dong-gu, Ulsan 682-813, South Korea
Jae Hee Seo, Department of Pathology, University of Ulsan College of Medicine, Ulsan University Hospital, Dong-gu, Ulsan 682-813, South Korea
Yang Won Nah, Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Ulsan College of Medicine, Ulsan University Hospital, Dong-gu, Ulsan 682-813, South Korea
Author contributions: Do GW, Jun JB and Nah YW designed the research, and provided the discussion of the clinical features; Seo JH provided the discussion of the pathology; Do GW and Jung SW wrote the paper.
Correspondence to: Yang Won Nah, MD, PhD, Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Ulsan College of Medicine, Ulsan University Hospital, 290-3 Jeonha-dong, Dong-gu, Ulsan 682-813, South Korea. nahyw@uuh.ulsan.kr
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Received: January 17, 2013
Revised: April 3, 2013
Accepted: April 28, 2013
Published online: June 14, 2013
Processing time: 148 Days and 6.7 Hours
Abstract

Mucormycosis is an uncommon opportunistic fungal infection with high mortality in liver transplant recipients. Mucormycosis of the gastrointestinal tract can manifest with features similar to ischemic colitis. Typically signs and symptoms of non-gangrenous ischemic colitis resolve spontaneously within 24-48 h. On the other hand, the clinical course of the mucormycosis is commonly fulminant. We encountered a case of invasive fungal colitis presenting with abdominal pain and hematochezia in a liver transplant recipient. Endoscopic examination showed multiple shallow ulcerations and edema with mucosal friabilities on the sigmoid and distal descending colon, which was consistent with ischemic colitis. However, the histological examination obtained from endoscopic biopsies showed fungal hyphae with surrounding inflammatory cells and mucosal necrosis. The patient was successfully managed with antifungal agent without surgical treatment. Thus, early diagnosis and treatment is essential for improving the prognosis of invasive fungal infection after liver transplantation.

Keywords: Mucormycosis; Liver transplantation; Colon; Ischemia