A Rare Cause of Intestinal Perforation.docVIP

A Rare Cause of Intestinal Perforation in an Extreme Low Birth Weight Infant — Gastrointestinal Mucormycosis: A Case Report K L?Siu?FHKAM (Paed)1 and W H?Lee?FRCP1 1Department of Paediatric, Queen Elizabeth Hospital, Hong Kong Correspondence: Kiu Lok Siu, FHKAM (Paed), Department of Paediatrics, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong. Top of page Abstract We report an extreme low birth weight infant with gastrointestinal mucormycosis (GM) mimicking necrotizing enterocolitis on day 15 of age. Emergency laparotomy confirmed ileal perforations. Subsequently, tissue histology confirmed GM. This is the most premature infant who survived after GM and is the third reported neonatal survivor in English literature. Top of page INTRODUCTION Intestinal perforation in extreme low birth weight (ELBW) babies is not uncommon. Common causes include bowel perforation in necrotizing enterocolitis (NEC), indomethacin treatment for patent ductus arteriosus1 and dexamethasone treatment for bronchopulmonary dysplasia.2 Occasionally, it can be spontaneous.3 We report a case of intestinal perforation in an ELBW infant as a result of gastrointestinal mucormycosis (GM). Top of page CASE REPORT A male ELBW infant was delivered by emergency Caesarean section at maturity of 26 week and 4 days because of placenta previa type III with antepartum haemorrhage and prolonged rupture of membrane. He was the second of a set of triplets conceived by in vitro fertilization. A course of antenatal dexamethasone was given prior to delivery. Apgar score was 2 and 7 at first and fifth minutes, and his birth weight was 839?g. Maternal high vaginal secretion for culture was negative. He developed hyaline membrane disease at birth and was treated with three doses of intratracheal surfactant. He developed symptomatic patent ductus arterisous on day 8 and was treated with intravenous indomethacin, which was stopped on day 11 when thrombocytopenia and raised serum creatinine appeared. In