Gastrointestinal Mucormycosis in an Immunocompetent Patient: A Diagnostic Dilemma

Mucormycosis is a rare fungal infection caused by mucorales. It mainly affects immunocompromised individuals. Mucormycosis can infect the gastrointestinal tract and the pathophysiology involves angioinvasion and necrosis of tissues. We report a 45 year old immunocompetent patient presenting with complaints of abdominal pain and constipation with left upper quadrant tenderness on examination. He was treated along the lines of intra-abdominal abscess but as his condition deteriorated, he underwent Exploratory laparotomy which showed ischemic bowel segments. Histopathology examination of tissue samples revealed non septate branching fungal hyphae consistent with invasive mucormycosis. Antifungal therapy was started and the patient underwent relook surgery, extensive bowel necrosis was found all looking non salvageable and the surgery was abandoned. This case report highlights the importance of keeping fungal aetiology in differentials of immunocompetent patients presenting with non-specific gastrointestinal symptoms with characteristic CT scan findings not responding to conventional antibiotic treatment. In addition, it is important to start prophylactic broad spectrum antifungals such as amphotericin B along with surgical interventions to prevent further systemic spread of the disease as delay in diagnosis can worsen the outcomes.