NEW DELHI: Two rare cases of mucormycosis in the small intestine were detected in the patients at a premier hospital in the national capital. These cases treated at Sir Ganga Ram Hospital were unique as both patients had Covid and small intestine (instead of stomach /colon) was involved in both. In the first case, a 56-year-old man who had tested Covid positive with mild symptoms had to be put on ventilator support as his situation worsened.
“His abdominal pain was considered gastritis/stress-related and self-medication for acidity was taken which delayed proper treatment by three days. He was finally evaluated in Covid emergency by Dr Ushast Dhir, senior consultant in the department of Surgical Gastroenterology and Liver Transplantation. The CT scan revealed his small intestine (jejunum) had perforated,” the hospital said in a statement.
“Ulceration of Jejunam (first part of small intestine) in the patient raised suspicion of fungal disease and the patient was immediately put on anti-fungal treatment. We sent the portion of the removed intestine for biopsy,” Dr Dhir noted. In another case, a 68-year-old had recovered from Covid, but started having mild abdominal pain. He was a diabetic and had received steroids for treatment of Covid.
The patient had no associated fever and the pain was very mild. His clinical examination also did not show any signs of intestinal perforation. “But, a high index of suspicion led Dr Piyush Ranjan, senior consultant of Medical Gastroenterology, to get an urgent CT scan for the patient. It revealed small intestinal perforation similar to the first one.
The biopsy confirmed Mucormycosis of the small intestine in both patients,” it added. Both these patients had diabetes but only one of them had received steroids. Dr Dhir, who operated on both, revealed that these patients had similar intraoperative findings where the first part of small intestine (jejunum) had outpouchings called diverticula and these diverticula had perforated along with surrounding ulceration.
“Intestinal or GI mucormycosis is a very rare disease and most commonly involves the stomach or large intestine. These patients in the majority are immune-compromised. Most of gastro-intestinal mucormycosis is seen in organ transplant recipients,” the hospital noted. “History of Covid exposure along with treatment with steroids should warrant an early CT scan of the abdomen,” the hospital said.