Gastric Zygomycosis in a Previously Healthy 56-Year-Old Male.
Zygomycosis refers to invasive fungal infections caused by fungi belonging to the phylum zygomycota. Infections generally occur in immunocompromised individuals. The following case is of a previously healthy 56 year-old male admitted to the hospital following a motor vehicle accident. During his hospitalization, there was a significant drop in hemoglobin with no obvious source of bleeding. This prompted the clinician to insert a nasogastric tube which returned at least 2 liters of black fluid and led to an upper gastrointestinal endoscopy. The endoscopy revealed numerous large crater-like gastric ulcers with adherent clot, up to 30 mm in greatest dimension. Biopsies of the ulcer margins revealed broad pauciseptate, ribbon-like, slightly refractile fungal forms, which were highlighted with periodic acid-Schiff (PAS) stain. A Gomori methanamine silver (GMS) stain was negative. These forms were suggestive of zygomycetes. A subsequent gastrectomy was performed, which revealed similar findings. The patient experienced severe trauma, which may have contributed to the progression of his condition; however, this is an unusual presentation as the patient was previously healthy, and he did not illustrate any conditions that might compromise his immunity. The severity and rarity of this condition makes this a very unique and intriguing case.