Unusual giant gastric cardia ulcer

Excerpt

A 70-year-old woman with medically uncontrolled type 2 diabetes mellitus presented with severe epigastric pain and emesis of bloody material (approximately 300 mL), and was sent to the emergency department. We performed fluid resuscitation, blood transfusion, and esophagogastroduodenoscopy (EGD). EGD revealed giant infiltrative ulceration with a poorly defined border and necrotic tissues on esophagogastric junction and cardia (Fig. 1a). The initial impression included malignancy of esophageal or gastric cardia. Forceps biopsy of the ulcerative border was performed, and microscopic findings showed broad hyphae without septation and an obtuse angle between hyphae. A Giemsa stain revealed largely irregular hyphae and distinct mucor species (Fig. 1b). The final diagnosis was gastrointestinal mucormycosis. The patient received liposomal amphotericin B (5 mg/kg/day) for 6 weeks. Improved intake conditions and no gastrointestinal bleeding were noted. Two months later, EGD was repeated, which showed an intact gastric mucosa.

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