{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T06:12:49Z","timestamp":1788415969709,"version":"build-2803163510"},"reference-count":19,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"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. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Mucormycosis is a rapidly progressive, life-threatening fungal infection that typically affects immunocompromised hosts. Disseminated peritoneal mucormycosis is extremely rare and often diagnosed late. Heatstroke is an under-recognized predisposing condition.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>\n                      A 54-year-old male brickworker developed peritoneal mucormycosis caused by\n                      <jats:italic>Rhizopus microsporus<\/jats:italic>\n                      following exertional heatstroke. On day 11 after heatstroke, he developed massive ascites. Ascitic fluid amylase was markedly elevated to 51,808 U\/L, while plasma amylase remained low (40.3 U\/L). Contrast study excluded perforation, and CT showed a normal pancreas. Sputum fungal culture grew\n                      <jats:italic>Rhizopus<\/jats:italic>\n                      species on day 4. Targeted next-generation sequencing (tNGS) of ascitic fluid and blood identified\n                      <jats:italic>R. microsporus<\/jats:italic>\n                      (151 and 53 reads). Tissue biopsy was precluded by severe coagulopathy and thrombocytopenia. The patient received liposomal amphotericin B (L-AmB) plus isavuconazole; subsequent detection of\n                      <jats:italic>Candida tropicalis<\/jats:italic>\n                      superinfection prompted a switch to caspofungin while continuing L-AmB. Ascitic fluid amylase declined progressively to 38 U\/L, with radiological resolution. The patient recovered without surgical debridement.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Extremely elevated ascitic fluid amylase with a normal pancreas and excluded perforation should prompt consideration of peritoneal mucormycosis. This case suggests that fungal-derived enzymes may contribute to the enzyme elevation, though this remains speculative without direct assays. Combination antifungal therapy achieved cure despite contraindications to surgery. Heatstroke is an important but under-recognized risk factor for disseminated mucormycosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1946492","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T05:16:19Z","timestamp":1788412579000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Extremely elevated ascitic fluid amylase as a diagnostic clue for peritoneal mucormycosis caused by Rhizopus microsporus following exertional heatstroke"],"prefix":"10.3389","volume":"13","author":[{"given":"Guanghui","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Clinical Pharmacy, The Central Hospital of Xiangtan (The Affiliated Hospital of Hunan University)","place":["Xiangtan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haibo","family":"Lei","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, The Central Hospital of Xiangtan (The Affiliated Hospital of Hunan University)","place":["Xiangtan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guyi","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, The Second Xiangya Hospital, Central South University","place":["Changsha, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanyan","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, The Second Xiangya Hospital, Central South University","place":["Changsha, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e405","DOI":"10.1016\/S1473-3099(19)30312-3","article-title":"Global guideline for the diagnosis and management of mucormycosis: an initiative of the European confederation of medical 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