Case two:
A 59 year old man originally from Cango living in Tunisia without any medical history presented to the hospital with gastric pain and vomiting and a fast worsening of the general state. At admission, he had fever with a temperature at 39°C. His blood pressure was low : 80/45 mmHg and his pulse was 110 BPM. Abdominal exam showed epigastric tenderness and a moderate ascites.Laboratory findings revealed severe normocytic anemia with 7.1 g/dL hemoglobin, elevated white blood cell count (WBC) 24 900 cells/µL (93% neutrophils) and thrombopenia at 72 000/mm3.He had high C-reactive protein (CRP) 231 g/L with a positive procalcitonin test (2.53 ng/ml). We concluded to a septic shock and the patient had broad-spectrum antibiotherapy and vascular filling with vasoactive drugs.
Upper gastrointestinal endoscopy revealed a very fragile mucosa and a gastric ulcer with bleeding stigmata (figure 6). Abdominal ultrasound was normal besides moderate ascites.
Anatomopathological exam showed typical broad zygomycetes hyphae (figure 7).
Six days later, the patient developped an hemophagocytic syndrome confirmed by cytological examination of the bone marrow. The evolution was rapidly fatal with continuous decrease in hemoglobin level despite transfusions and the patient died within 8 days after admission.