PMC5614730_01
Diagram representing location of 8 gunshot wounds upon initial presentation.
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HIV positive African American male with a history of gastrointestinal CMV, CNS mycobacterium avium infection(MAC), and immune reconstitution inflammatory syndrome(IRIS) on prednisone who initially presented to our level I trauma center with eight gunshot wounds to the abdomen (Fig. 1).
CT scan with oral contrast: enteric contrast within the left pleural space with an apparent open communication between the stomach and pleura. There is also continued collapse/consolidation in the left to right mediastinal shift after the placement of a chest tube.
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A CT scan with oral contrast revealed a communication between the stomach and the left pleural space correlating with high chest tube output (Fig. 2).
Gross specimen of stomach (wide arrow) and GE junction (narrow arrow). Demonstrating hemorrhage and necrosis involving the mucosa and muscularis.
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The body of the stomach showed hemorrhagic mucosa, and devitalized serosa with thrombosed veins on the exterior surface (Fig. 3). Three specimens including the stomach, GE junction, and the diaphragm were sent for evaluation (Fig. 3).
(Left) Hematoxylin & Eosin Stain of the stomach. Arrows pointing to broad, nonpigmeneted, non-septated hyphae with right angle branching consistent with Mucor. (Right) Gomori methenamine-silver stain demonstrating Mucor.
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Microscopic sections showed invasive fungal hyphae, described as broad, non-septate, with branching consistent with the Mucor genus (Fig. 4).
Hematoxylin & Eosin Stain of the stomach. L - vessel lumen. Thick arrow - demonstrating angioinvasion by Mucor sp.
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Angioinvasion, thrombosis, hemorrhage, and necrosis were also seen (Fig. 5).