A 46-year-old male patient, diagnosed with classical Hodgkin's lymphoma, mixed cellularity variety, stage IV-B with medullary, hepatic and splenic involvement, undergoing treatment with chemotherapy (escalated BEACOPP). In the induction phase of chemotherapy (day 11) he began with fever, chills and melena. Laboratory tests showed neutropenia (100 leukocytes/mm3) and platelets. He was admitted to the ICU for acute respiratory failure and during admission suffered lower gastrointestinal bleeding with hypovolemic shock, which required intubation and transfusion of blood products. Upper endoscopy identified a large ulceration in the proximal jejunum measuring 2-3 cm, with smooth edges and a necrotic background, with no active bleeding. The pathology study of the biopsy taken from the edges of the ulcer showed several fragments of small intestine mucosa, some ulcerated, with a dense mixed inflammatory infiltrate, with numerous foreign body giant cells, identifying abundant thick non-septate hyphae in their cytoplasm and among the infiltrate, compatible with mucormycosis. CT scan identified a thickening of the intestinal wall in jejunum, 4.5 cm in diameter, and multiple hypodense lesions in both hepatic lobes and lytic involvement in vertebral bodies at dorsal and lumbar level.
Treatment was started with amphotericin B, with glycaemic control, and eradicatory surgery was considered. The patient underwent surgery, which revealed a plastron located in the jejunum with involvement of the transverse mesocolon, with double perforation covering the jejunum. The anatomopathological study of the jejunum and ileum resection specimen showed ulceration and intense acute and chronic inflammation with double perforation and adhesion of loops, secondary to infection by Zygomycetes of the mucor type, with extensive fibrinoid necrosis of the medium-sized vessels of the subserosal fat. The hyphae are thick, of variable diameter, branching at different angles and in coronal sections show a clear, reinforced membrane. The hyphae were PAS and methanamine silver positive for fungi. The patient had no complications from the surgery. At one year follow-up the patient is still alive and his lymphoma is in remission.