A rare case of fatal gastrointestinal mucormycosis in a toddler diagnosed at medico-legal autopsy: a case report

Introduction: Gastrointestinal (GI) mucormycosis is a rare, rapidly progressive, and life-threatening angio-invasive fungal infection caused by fungi of the order Mucorales. It predominantly affects immunocompromised individuals and is associated with high mortality, particularly in infants and neonates. Owing to its nonspecific clinical presentation, diagnosis is frequently delayed or established post-mortem.
Case Presentation: We report the case of an 18-month-old toddler with a history of marginal prematurity, intrauterine growth restriction, malnutrition, and iron-deficiency anaemia who presented with abdominal distension, vomiting, and diarrhoea. The child was on a balanced diet with oral iron supplementation. He was initially managed for acute viral gastroenteritis; however, his clinical condition rapidly deteriorated, with the development of blood-stained stools and subsequent sudden cardiac arrest. Resuscitation was unsuccessful. A medico-legal autopsy revealed inflamed bowel loops and multiple gastric ulcers without perforation. Histopathological examination of the stomach demonstrated ulcerated mucosa with extensive necro-inflammatory debris and numerous broad, aseptate, ribbon-like fungal hyphae with angio-invasion. Grocott methenamine silver staining confirmed features consistent with GI mucormycosis.
Conclusion: This case highlights GI mucormycosis as a rare but fatal cause of acute gastrointestinal illness in children, particularly in the presence of predisposing factors such as malnutrition and iron deficiency anaemia on top of marginal prematurity. The nonspecific clinical features may mimic common gastrointestinal conditions, leading to missed or delayed diagnosis. Prompt and appropriate medical treatment, together with early histopathological confirmation in cases of presumptive or suspected mucormycosis, is essential to facilitate timely intervention for optimal outcomes.