Green ulcer in the stomach: unusual mucormycosis infection - 23/08/11
Doi : 10.1016/j.gie.2008.02.076
| Commentary The color green, so abundant in nature, signifies growth, renewal, health, and the environment, but it also has negative connotations of jealousy, envy, and inexperience. So many meanings for a wavelength of 510 nm! What did it mean in this case? Certainly nothing good. Mucormycosis refers to several different diseases caused by fungi in the class Phycomycetes and of the order Mucorales, Rhizopus being the most frequent species. It is unusual, however, that species is determined, and diagnosis usually doesn’t get more specific than “mucor.” Mucoraceae are ubiquitous fungi that are commonly found in soil or in decaying matter, but disease is unusual because of the low virulence of the organisms, which mainly affect immunocompromised individuals (eg, poorly controlled diabetes, glucocorticosteroid use, neutropenia in the setting of hematological or solid malignancy, transplantation, and burns). Infection usually follows local exposure, and most common is disease of the facial sinuses. Ingestion of conidia leads to GI disease that most commonly affects the stomach, ileum, and colon. Once spores begin to grow, fungal hyphae invade tissue and blood vessels, producing thrombosis, infarction, and necrosis. Invasion must be distinguished from colonization. Did this patient have an ulcer that was colonized by mucormycosis, or did the fungus cause the ulcer? Gastric ulcers occasionally fail to heal with proton pump inhibitor (PPI) therapy because they are colonized and coated with candida; only after adequate anticandidal therapy will PPIs be effective. Mucormycosis may be another colonizing and membrane-producing disease, but in this patient it is more likely to have been causative. Lawrence J. Brandt, MD Associate Editor for Focal Points |
© 2008
American Society for Gastrointestinal Endoscopy. Publié par Elsevier Masson SAS. Tous droits réservés.
Vol 68 - N° 3
P. 566-567 - septembre 2008 Retour au numéro
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