Abstract Background Mucormycosis is an aggressive opportunistic infection caused by filamentous fungi of the order Mucorales. Gastrointestinal (GI) involvement is rare, accounting for fewer than 7% of reported cases, and carries a mortality rate exceeding 90%. We report a unique case of primary gastric mucormycosis occurring in a patient with necrotizing pancreatitis and a history of chronic geophagia, an exceptionally uncommon route of exposure. Case Presentation A 50-year-old female with end-stage renal disease on hemodialysis, type 2 diabetes mellitus, and chronic ingestion of soil mixed with cleaning agents presented with abdominal pain and persistent emesis one week after hospitalization for necrotizing pancreatitis. Laboratory workup was notable for anemia (hemoglobin 7.3 g/dL), elevated creatinine (3.93 mg/dL), total bilirubin of 1.6 mg/dL, AST of 71 U/L, ALT of 32 U/L, and alkaline phosphatase of 1,192 IU/L. Computed tomography (CT) demonstrated worsening necrotizing pancreatitis with fistulization between the pancreatic tail and stomach. Endoscopic evaluation confirmed a cystogastrostomy with walled-off necrosis; biopsy of nodular gastric mucosa revealed broad, ribbon-like, non-septate hyphae consistent with mucormycosis. Micafungin was discontinued and intravenous liposomal amphotericin B was initiated. Despite antifungal therapy and repeated endoscopic interventions, the patient’s condition deteriorated. Surgical resection was precluded by poor clinical status, and she ultimately transitioned to comfort care. Discussion Gastric mucormycosis remains an exceedingly rare manifestation of Mucorales infection, typically affecting immunocompromised hosts, particularly those with diabetes, renal failure, or corticosteroid exposure. However, cases have been documented in immunocompetent individuals, suggesting that mucosal injury, ischemia, or environmental exposure—such as chronic geophagia—may serve as independent risk factors. The angioinvasive nature of Mucorales leads to extensive tissue necrosis, infarction, and perforation, contributing to its high fatality rate.Definitive diagnosis relies on endoscopic biopsy with histopathology, as culture yield is limited. Prompt initiation of antifungal therapy with lipid formulations of amphotericin B, combined with surgical debridement when feasible, remains the cornerstone of management. Adjunctive use of triazoles such as posaconazole or isavuconazole may be considered for refractory or step-down therapy. Conclusion This case highlights a rare presentation of gastric mucormycosis associated with necrotizing pancreatitis and chronic soil ingestion, expanding the spectrum of potential risk factors and routes of infection. Early recognition, tissue diagnosis, and aggressive multidisciplinary management are essential to improve outcomes in this highly lethal disease. This abstract is funded by: None
Altaf et al. (Fri,) studied this question.
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