Development of Mucormycosis Colitis during Prolonged Hospitalization

A 50-year-old woman with previously well-controlled type-2 diabetes developed hematochezia during hospitalization for cerebral vasculitis. She had been treated with intravenous methylprednisolone (1,000 mg) for three days, requiring an insulin drip before transitioning to daily maintenance prednisone (60 mg). She was hemodynamically stable with a soft, tender abdomen on exam. An abdominal/pelvic computed tomography (CT) scan demonstrated mucosal and colonic wall thickening with edema around the transverse, descending, and rectosigmoid colon. Colonoscopy revealed multiple non-bleeding ulcers 10–18 mm in size in the rectum, sigmoid, and descending colon, with normal surrounding tissue (Figure 1); the procedure was aborted given the extent of ulceration. Pathology from biopsies taken during the procedure confirmed mucormycosis (Figure 2). Amphotericin B and caspofungin were initiated, while prednisone was tapered off to minimize further immunosuppression. The patent experienced recurrent hematochezia with progressively worse pancolitis on repeat CT of the abdomen and pelvis. Given her increasingly worse prognosis despite medical management and the unlikelihood of surviving an aggressive colectomy, colorectal surgeons recommended against surgical intervention. She ultimately chose to transition to hospice care.