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.