A rare cause of Emergency Department visit for melena: Gastric Mucormycoma mimicking Adenocarcinoma

“Mucormycosis” is an extremely rare infection typically occuring in individuals with impaired immunity. Gastrointestinal Mucormycosis is the rarest form, and shows the highest mortality rate (50-85%). The diagnosis mostly depends on histological examination. Although culture can identify the fungal species, it is positive in only 52% of autopsy cases and 30% of surgical specimens. No reliable serologic or skin tests are available as yet. We describe a rare case of gastric mucormycoma, presenting to the Emergency Department (ED) for melena, and the potential pitfalls encountered during its evaluation and treatment. In our patient gastroscopy showed a large infiltrative and ulcerated mass located in gastric fundus and extended up to the gastro-esophageal junction. Hystology of bioptic specimens showed findings suggestive of gastric adenocarcinoma, leading the patient to surgery, consisting of total gastrectomy with esophagodigiunal and enteroenteric anastomosis. Our patient had no typical risk factor for Mucormycosis, and we suppose that the feeding by nasogastric tube, possibly through contamination by paranasal sinuses, could have caused the disseminated fungal strains, supported by a transient immunity derangement occurred during the ICU staying.