case_images: PMC11795065_01
case_images: Yellow arrows delineate the focal discontinuity suggestive of a perforated gastric ulcer, while the red arrows highlight areas of free air.
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case_images: PMC11795065_01_gr1.jpg
case_images: fig1
case_images: There was also a focal discontinuity in the wall of the gastric antrum, which was suspected to represent a perforated gastric ulcer (Fig. 1).
case_images: Pauciseptate fungal hyphae with irregularly shaped walls and 90-degree branching. Intercalary chlamydoconidia, both singly and in chains, were present, measuring 10-15 mum in diameter.
case_images: gr2.jpg
case_images: PMC11795065_01_gr2.jpg
case_images: fig2
case_images: Morphology on GMS stain was consistent with a fungus of the family Mucoraceae (see Fig. 2).
case_images: PMC11795065_02
case_images: (3A). 2.9 cm fluid density in the left lobe of the liver (3B). Complex fluid collection in the left lobe of the liver with surrounding hypodense satellite lesions, significantly increased from prior. (3C). Interval increase in the complex fluid collection without evidence of extravasation; satellite lesions also increased in size and number. (3D). Increase in satellite lesions around primary stable fluid collection.
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case_images: fig3
case_images: A CT pulmonary angiogram was performed that excluded a pulmonary embolism, but he was incidentally found to have a new 2.9 cm fluid collection in the left lobe of the liver, suspected to be a liver cyst (Fig. 3A). CT of the abdomen was obtained, and a complex fluid collection that was significantly increased in size compared to the CT from day +24 was seen (see Fig. 3B). Repeat abdominal CT imaging on Day +35 was obtained and showed an interval increase in the complex fluid collection and the satellite lesions (Fig. 3C). Despite antifungal treatment, repeat abdomen imaging on Day +45 showed increased sizes of the satellite lesions (Fig. 3D).
case_images: Fungal stain of the direct specimen showing broad, distorted hyphae.
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case_images: fig4
case_images: A filamentous fungus grew on Day +41, phenotypically identified to the genus level as Mucor spp. (Fig. 4).
case_images: The gross appearance of the left hepatectomy revealed an 8.0 x 5.0 cm of adherent, shaggy fibrous tissue, which was tan-gray and partially softened. The specimen was sectioned to reveal a multifocal tan-yellow, poorly circumscribed, centrally cavitated necrotic abscess.
case_images: gr5.jpg
case_images: PMC11795065_02_gr5.jpg
case_images: fig5
case_images: On Day +59 the patient underwent a right liver hepatic lesion wedge resection, left hepatectomy, and cholecystectomy (Fig. 5).
case_images: GMS stain reveals pauciseptate, broad, irregular hyphae consistent with a member of the family Mucoraceae.
case_images: gr6.jpg
case_images: PMC11795065_02_gr6.jpg
case_images: fig6