CORRESPONDENCE First case of gastrointestinal mucormycosis in an immunocompromised patient with gallbladder and duodenum involvement E. Lacarrie `re • L. Lacaze • L. Schwarz • E. Huet • F. Lemoine • M. Scotte ´ Received: 3 March 2011 / Accepted: 7 July 2011 / Published online: 23 July 2011 Ó Springer-Verlag 2011 Mucormycosis is an infection caused by fungi from the Mucorales group. The first case of mucormycosis was described by Paltauf in 1885. It occurs mostly, but not exclusively, in immunodeficient patients. The most fre- quent predisposing affections are: hematological or solid malignancies, neutropenia, use of corticosteroids, solid organ or stem cell transplant, diabetic or metabolic acido- sis, iron overload or deferoxamine use, and malnourish- ment [1]. The most commonly affected organs include, from the most to less frequent: brain and sinuses, lungs, skin, gastrointestinal (GI) tract, and miscellaneous [2]. Due to the lack of specific clinical symptoms and often altered states, early diagnosis is rarely obtained, leading to a high mortality rate. GI mucormycosis is a rare disease, often diagnosed post-mortem, usually associated with such symptoms as GI bleeding, abdominal pain and distension, and nausea and vomiting. We report the case of a patient with acute leukemia, who developed GI mucormycosis with gallbladder and suspected duodenal involvement. Extensive research was performed in the PubMed, Embase, and Ovid libraries, using the keywords mucormycosis, zygomycosis, gastrointestinal mucormycosis, necrotizing cholecystitis, peritonitis. No occurrence of mucormycosis with gallbladder or duodenal involvement was found. A 59-year-old male patient was transferred from the Hematological Unit to the Intensive Care Unit (ICU) at day 36 of his induction chemotherapy (clofarabine–aracytine) for type 7 acute myelogenous leukemia (FAB classifica- tion) with poor prognosis karyotype (monosomy 5 and 7). Upon admittance, he presented fever associated with diarrhea, GI bleeding, acute renal failure, and hypovolemic shock, as well as jaundice. GI symptoms had been present for 2 weeks. Neutropenia had been present for 30 days. Computed tomography (CT) scanning only demonstrated signs of potential colitis, unconfirmed by endoscopy or biopsy. One blood culture yielded Escherichia coli. Stool cultures and urine cultures were negative. The patient had received a combination of antibiotics (piperacillin ? tazobactam) associated with teicoplanin and metronidazole, then imipenem (instead of piperacillin ? tazobactam) and antifungal therapy (caspofungin then liposomal amphoteri- cin B after 12 days). None produced an improvement in the clinical signs. The antifungal therapy was stopped after 16 days of ongoing sepsis, despite persistent neutropenia. Upon arrival at the ICU, the patient began to overcome aplasia: white blood cell (WBC) count was 1,000/mm 3 , platelets were 25,000/mm 3 . His prothrombin ratio was 30% and his factor V rate was 60%, suggesting either con- sumption coagulopathy or hemophagocytic syndrome. He was intubated upon arrival and noradrenaline support was introduced. Duodenoscopy was carried out and revealed a large duodenal ulcer. Double-dose proton pump inhibitors were introduced. No samples were taken for either culture or histology, despite ongoing sepsis. Three days after admission, noradrenaline doses were increased, due to worsening of the patient’s state. A CT scan was conducted, showing localized pneumoperitoneum with juxtaduodenal abscess, suggesting ulcer perforation (Fig. 1). No lung infection was noted. Emergency surgery was decided after E. Lacarrie `re Á L. Lacaze Á L. Schwarz Á E. Huet Á M. Scotte ´(&) Department of Digestive Surgery, Rouen University Hospital, Charles Nicolle, 76031 Rouen Cedex, France e-mail: michel.scotte@chu-rouen.fr F. Lemoine Department of Pathology, Rouen University Hospital, 76031 Rouen Cedex, France 123 Infection (2011) 39:595–598 DOI 10.1007/s15010-011-0165-x