Table 1.

Summary of cases of invasive mucormycosis in patients with inflammatory bowel disease described in the literature.

	Case  1	Case  2	Case  3	Case  4	Case  5	Case  6	Case  7
Age (y)/sex	68/M	52/F	41/F	37/M	32/M	59/F	60/M
Risk factor	Ulcerative colitis; diabetes mellitus	Crohn's disease	Crohn's disease; diabetes mellitus  (well controlled)	Ulcerative colitis	Crohn's disease	Ulcerative colitis status posttotal colectomy 20 y prior to admission.	Inflammatory bowel disease
Treatment for IBD	Chronic corticosteroids		Azathioprine and infliximab	Corticosteroids, mesalazine	Infliximab infusions, oral 6 mercaptopurine (6 MP), and oral and intravenous corticosteroids	Methotrexate, corticosteroids	Intravenous corticosteroids, oral 6-MP, and oral sulfasalazine
Initial symptoms	Fever, cough, and chest pain. Nonresolving pneumonia	Peritonitis followed by intestinal perforation	Nasal congestion, fullness, headache, and fevers	Exacerbation of underlying condition.   In-hospital course: fever, septic shock, trans esophageal echocardiogram: 6 × 1.8 cm right atrial mass	Severe abdominal pain.    CT scan abdomen and pelvis: recurrent pneumoperitoneum	Nonhealing periosteal lesion resembling pyoderma gangrenosum	High fever, nausea, vomiting, bloody diarrhea, and pain in right flank
Presentation form  of mucormycosis	Pulmonary    Bronchoscopy: soft tissue mass obstructing the bronchus intermedius suggestive of fungal pneumonia	Gastrointestinal	Sinus	Endocarditis; suspected hematogenous spread to lungs with multiple nodal lesions with central necrosis on chest computed tomography (CT)	Gastric perforation	Cutaneous	Disseminated (colon and right kidney)
Diagnosis of mucormycosis	Antemortem biopsy of bronchial mass: ulcerated bronchial wall with ischemic necrosis, fibrinopurulent exudates, and hyphae suggestive of mucormycosis	Postmortem: colon tissue: hyphae suggestive of Mucorales, cultures positive for Rhizopus microsporus     Peritoneal fluid: microscopic exam: broad irregular hyphae, culture: Rhizopus microsporus	Antemortem: sinus biopsy: hyphae suggestive of Mucorales	Antemortem: histopathology of atrial endocardial vegetation showed mycotic hyphae.   Microbiologic cultures of atrial appendage positive for Mucor spp.	Antemortem: abdominal wall: histopathology: many broad based nonseptate hyphae admixed with necrotic tissue.	Antemortem: cutaneous biopsy of new periosteal ulcer: hyphae suggestive of Rhizopus spp. on calcofluor white test.   Culture of periosteal ulcer grew Rhizopus spp.	Antemortem: right kidney: histopathology: large areas of necrosis. Blood vessel walls invaded by hyphae suggestive of Mucorales.     Culture of right kidney positive for Absidia corymbifera
Treatment	Pneumonectomy Amphotericin B, caspofungin	Voriconazole	Surgical debridement and extensive facial tissue resection.   Amphotericin B for 30 days, 6 m course of posaconazole.	Excision of intracardiac mass.    Liposomal amphotericin B 5 mg/kg.	Surgical debridement, cholecystectomy.   Liposomal amphotericin B (abelcet) 350 mg IV daily	Surgery not done due to medical complications.    Liposomal amphotericin B (abelcet). Followed by oral itraconazole for 3 months.	Elective right nephrectomy, total colectomy.   Amphotericin B (0.7 mg/kg/d)
Outcome	Worsening of infection while on antifungals with spread to left upper lobe lung and pericardium.   Died	Died	Alive, off antifungals, and immune suppression	Alive, off antifungals,and immune suppression	Died	Alive, off antifungals, and immune suppression	Died
Year/reference	2012 [19]	2010 [14]	2009 [10]	2007 [17]	2007 [12]	2002 [16]	1997 [15]