Gastrointestinal mucormycosis associated with leptospirosis: should we be concerned during major floods?

Abstract

Gastrointestinal mucormycosis (GIM) and leptospirosis are two severe diseases associated with high morbidity and mortality rates. The coexistence of these two conditions has not yet been reported in the literature. This study presents a case involving this rare association. A 49-year-old man from Sao Paulo, Brazil, was hospitalized with acute abdominal pain, low blood pressure, and jaundice. He had a history of contact with floodwater and ingestion of contaminated water, was hospitalized with acute abdominal pain, low blood pressure, and jaundice. Upon ICU admission, he developed jaundice, acute renal failure requiring hemodialysis, and alveolar hemorrhage necessitating intubation. Leptospirosis was confirmed by serological tests and treated with ceftriaxone for 14 days. Two weeks later, he developed severe enterorrhagia, requiring a massive transfusion and a total colectomy with terminal ileostomy. Histopathology revealed necrotizing granulomatous inflammation with hyphae indicative of mucormycosis. He was treated with amphotericin B for 7 weeks, followed by posaconazole. Abdominal CT scans over the next five months showed complete clinical and radiological improvement. The association between mucormycosis and leptospirosis has not been previously documented, highlighting the diagnostic challenges and the critical importance of early detection. Successful management in this case required timely surgical intervention combined with prolonged antifungal therapy.