{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T06:04:53Z","timestamp":1790661893618,"version":"4.1.0"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Fungal Biol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Mucormycosis is an aggressive angioinvasive fungal infection that predominantly affects chronically immunosuppressed individuals. Hematogenous dissemination of\n                      <jats:italic>Mucorales<\/jats:italic>\n                      causing synchronous gastric full-thickness perforation and total splenic infarction is exceptionally rare, particularly in immunocompetent hosts without chronic comorbidities. To our knowledge, this presentation has not been reported in a patient with only three days of stress-dose glucocorticoid therapy following sigmoid perforation and septic shock.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>\n                      We report a fatal case of synchronous gastric perforation and total splenic infarction secondary to hematogenous\n                      <jats:italic>Mucorales<\/jats:italic>\n                      dissemination in a previously healthy adult who developed septic shock from spontaneous sigmoid perforation. The patient received only three days of guideline-recommended stress-dose hydrocortisone and had no pre-existing diabetes, malignancy, or organ transplantation. Routine serum 1,3-\u03b2-D-glucan testing and peritoneal fungal cultures were both negative. Empirical micafungin, an echinocandin, was administered for eight days before liposomal amphotericin B was initiated, during which time progressive fungal angioinvasion led to irreversible multi-organ failure and death. Histopathology confirmed broad, aseptate, right-angle branching hyphae invading gastric and splenic vessels, whereas no fungal elements were detected at the primary sigmoid lesion, supporting a predominantly hematogenous dissemination pathway without primary intestinal fungal colonization \u2013 an unprecedented finding that fundamentally distinguishes this case from classic primary gastrointestinal mucormycosis. These histopathological findings are biologically consistent with the CotH3 (CotH family protein 3) \u2013 GRP78 (glucose- regulated protein 78\u00a0kDa) host\u2013fungal virulence axis, which represents a plausible mechanistic explanation for multi-organ angioinvasion observed in this patient.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      This case delivers three critical clinical takeaways. First, even brief stress-dose glucocorticoids may induce sufficient transient immune paralysis to permit life-threatening hematogenous mucormycosis in patients without chronic underlying immunosuppression, acting as one potential contributing factor alongside sepsis-related critical-illness immune dysfunction. Second, empirical carbapenem plus echinocandin regimens, commonly used in ICUs, lack activity against\n                      <jats:italic>Mucorales<\/jats:italic>\n                      ; prolonged reliance on this combination can result in irreversible fatal visceral injury. Third, negative peritoneal fungal cultures and serum 1,3-\u03b2-D-glucan do not exclude intra-abdominal mucormycosis; early re-laparotomy for histopathological biopsy is essential in refractory cases.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/ffunb.2026.1940494","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T05:46:21Z","timestamp":1790660781000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case report: Fatal hematogenous gastrosplenic mucormycosis in an immunocompetent adult following sigmoid perforation, septic shock, and short-term stress glucocorticoids"],"prefix":"10.3389","volume":"7","author":[{"given":"Jiewei","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Fuzong Clinical Medical College of Fujian Medical University","place":["Fuzhou, Fujian, China"]},{"name":"Department of Emergency, 900th Hospital of PLA Joint Logistic Support Force","place":["Fuzhou, Fujian, China"]},{"name":"Department of Emergency Medicine, Fuzong Teaching Hospital of Fujian University of Traditional Chinese Medicine (900th Hospital)","place":["Fuzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Fuzong Clinical Medical College of Fujian Medical University","place":["Fuzhou, Fujian, China"]},{"name":"Department of Emergency, 900th Hospital of PLA Joint Logistic Support Force","place":["Fuzhou, Fujian, China"]},{"name":"Department of Emergency Medicine, Fuzong Teaching Hospital of Fujian University of Traditional Chinese Medicine (900th Hospital)","place":["Fuzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hua","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Fuzong Clinical Medical College of Fujian Medical University","place":["Fuzhou, Fujian, China"]},{"name":"Department of Emergency, 900th Hospital of PLA Joint Logistic Support Force","place":["Fuzhou, Fujian, China"]},{"name":"Department of Emergency Medicine, Fuzong Teaching Hospital of Fujian University of Traditional Chinese Medicine (900th Hospital)","place":["Fuzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.12659\/ajcr.948878","article-title":"Invasive gastrointestinal mucormycosis presenting as neutropenic enterocolitis: a case report","volume":"26","author":"AlBassam","year":"2025","journal-title":"Am. 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