Ileal Mucormycosis Causing Bleeding in Necrotizing Pancreatitis

Abstract

A60-year-oldmanwith a history of type 2 diabetesmellitus andwith gallstone pancreatitis was admitted to an outside institution.He underwent endoscopic retrograde cholangiopancreatography with biliary sphincterotomy and placement of a common bile duct stent. The patient was transferred to our institution after he developed necrotizing pancreatitis complicated by anuric renal failure requiring hemodialysis. His pancreatitis was conservatively managed. Eleven days following endoscopic retrograde cholangiopancreatography, the patient developed hematochezia with an associated hemoglobin decrease from 9.4 to 7.1 g/dL. Computed tomography demonstrated subtle ileal wall thickening (Figure 1). Esophagogastroduodenoscopy revealed no post-sphincterotomy bleeding or other etiologies to explain his anemia. Colonoscopy revealed an inflamed terminal ileumwith friable mucosa containing stigmata of recent bleeding andwas extensively biopsied (Figure 2). Histopathology displayed numerous branching hyphal elements, and fungal polymerase chain reaction testingwas positive forRhizopus (Figure 3). The patientwas initiated onposaconazole andmay ultimately require surgical resection of the affected bowel.