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Journal of Postgraduate Medicine, Vol. 55, No. 1, January-March, 2009, pp. 73-74 Letter Primary gastric mucormycosis: Role of preexisting ulcerative and erosive lesions Benjamin SPE School of Medicine, AIMST University, 31 / 2, Bukit Air Nasi, Jalan Bedong Semeling, 08100 Bedong, Kedah Darul Aman, West Malaysia Code Number: 09010 Sir, The article entitled "Primary gastrointestinal mucormycosis in an immunocompetent person" by Shiva Prasad BN, et al., [1] in the July 2008 edition of the Journal of Postgraduate Medicine was informative. Though the authors consider that there are no predisposing factors, the presence of a gastric ulcer may be considered a predisposing factor. An unperforated gastric ulcer of this size is likely to be chronic. Acute ulcers are often small and multiple. Predisposing factors for gastric ulcers like smoking, alcohol ingestion, etc need to be mentioned. [2],[3] Gastric mucormycosis has been reported in smokers and alcoholics. [2],[3],[4] Even in the immunocompromised it is more often seen in patients who have risk factors for ulcerative or erosive gastritis. It is more often reported with transplant recipients who are on steroids than in other immunosuppressed states. [5],[6] Often the underlying peptic ulcer disease may be asymptomatic. Some authors have suspected it on the basis of circumstantial evidence or the presence of subserosal fibrosis on gastrectomy specimen. [5],[7] A study of 20 cases of gastrointestinal mucormycosis found that 10 of them had peptic ulcer disease. [8] Prednisolone-induced gastrointestinal mucormycosis has been demonstrated in animal studies. [9] In the absence of systemic immunosuppression, a breach in the gastric mucosa might be an important predisposing factor for the condition. References
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