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Case Report
  |   Neonatal Med_24_3_134_139.pdf
Neonatal Med August;24(3):134-139.
Published online 2017 August 31
Copyright ⓒ 2017 Neonatal Medicine Neonatal Medicine
Gastrointestinal Mucormycosis in Extremely Low Birth Weight Infants Mimicking Atypical Necrotizing Enterocolitis and Intussusception
Heul Jun, M.D., Dong Hyuk Lee, M.D., Young Hwa Song, M.D., Jung Min Yoon, M.D., Eun Jung Cheon, M.D., Kyung Ok Ko, M.D., Si Min Park, M.D.*, and Jae Woo Lim, M.D.
Departments of Pediatrics and Surgery*, Konyang University College of Medicine, Daejeon, Korea
Corresponding Author: Jae Woo Lim , Tel: +82-42-600-9230 , Fax: +82-42-600-9090 , Email: limsoa@hanmail.net
ABSTRACT
Neonatal gastrointestinal mucormycosis, a rare disease with a high mortality rate, shows a rapid progressive course in premature infants with an immature immune system. We report the case of a male neonate weighing 970 g, delivered via cesarean section at 27 weeks, as one of a pair of dizygotic twins. From the 7th day after birth, bile was seen to drain through the orogastric tube, and paralytic ileus was noted on performing an abdominal X-ray. Thus, oral feeding was discontinued because necrotizing enterocolitis (NEC) was highly suspected. On the 9th day after birth, a firm mass was palpable in left upper abdominal quadrant, but no pneumatosis intestinalis was observed on performing abdominal X-ray. Small bowel intussusception was suspected on performing abdominal ultrasonography. Based on these findings, an exploratory laparotomy was performed, and although no intussusception was found intraoperatively, we performed a partial gastrectomy and hemicolectomy due to the presence of necrotic changes and perforations of the stomach and colon. Postoperatively, he was observed to have hypotension with persistence of hemorrhage at the surgical site. He died on the 11th day after birth. Intraoperative histopathological examination of stomach and colon showed fungal aseptate hyphae with broad branching. Gastrointestinal mucormycosis was confirmed based on findings of vascular involvement in the form of fungal hyphae and thrombosis in the transmural blood vessels. We report a case of an extremely low birth weight infant with neonatal gastrointestinal mucormycosis with an initial clinical presentation suggestive of intussusception and atypical NEC.
Keywords: Mucormycosis, Necrotizing enterocolitis, Intussusception, Low birth weight infant, Candida, Fungi
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