University of Colorado Anschutz Medical Campus Denver, CO
Ahmed Shahatta, MBChB1, Hayder Alamily, MD2, Sana Rabeeah, MD3, Sajjad Al-Badri, MBChB4, Karrar Shakir, MBChB5, Ban Mashadani, MD6, Bisher Sawaf, MD7, Mohannad Bitar, MD8, Mushfiqur Siddique, MD8, Omer Najem, MD9, Abdulrahman Khaldoon. Hamid, MD10, Omar Saab, MD11 1College of Medicine, Dhi Qar University, Dhi Qar, Dhi Qar, Iraq; 2University of Colorado Anschutz Medical Campus, Denver, CO; 3The University of Toledo, Toledo, OH; 4College of Medicine, University of Baghdad, Baghdad, Baghdad, Iraq; 5Baghdad teaching hospital, Baghdad, Baghdad, Iraq; 6Baptist Health-University of Arkansas for Medical Sciences, North Little Rock, AR; 7University of Toledo Medical Center, Toledo, OH; 8Jamaica Hospital Medical Center, Jamaica, NY; 9Department of internal medicine, Trinity Health Oakland, Pontiac, MI; 10Jamil Tutanji Hospital, Amman, 'Amman, Jordan; 11University of Texas Health Science Center, Houston, TX Introduction: Mucormycosis is a rare but potentially fatal fungal infection primarily affecting immunocompromised individuals. Gastrointestinal involvement, especially gastric mucormycosis, is uncommon and often diagnosed late due to nonspecific symptoms. Euglycemic diabetic ketoacidosis (DKA), a recognized complication of sodium-glucose cotransporter 2 (SGLT2) inhibitors, may exacerbate immunosuppression in poorly controlled diabetics. We report a case of invasive gastric mucormycosis in a patient with uncontrolled type 2 diabetes mellitus (T2DM) following inappropriate substitution of insulin with an SGLT2 inhibitor.
Case Description/
Methods: A 54-year-old male with poorly controlled T2DM presented with severe epigastric pain and vomiting following recent hospitalization for euglycemic DKA after cessation of insulin therapy and initiation of an SGLT2 inhibitor. Esophagogastroduodenoscopy revealed two necrotic gastric ulcers, one subcardial and another 5–6 cm in the mid-gastric body, with retained food suggestive of gastroparesis. Biopsies and fungal culture confirmed heavy growth of Mucor species, with broad, non-septate, right-angle branching hyphae. He was treated with oral posaconazole and re-initiation of insulin. Despite treatment, symptoms recurred, requiring multiple hospitalizations. Discussion: This case emphasizes two key considerations: (1) the risk of euglycemic DKA from SGLT2 inhibitors in uncontrolled diabetes, and (2) the importance of including invasive fungal infections in the differential for necrotic gastric ulcers in immunocompromised patients. Early biopsy and fungal culture are essential for diagnosis. Recurrence may occur despite antifungal therapy if metabolic derangements persist. Clinicians should maintain a high index of suspicion for mucormycosis in diabetic patients with atypical gastric ulcers, especially after SGLT2 inhibitor use. Prompt diagnosis and metabolic control are critical for improving outcomes.
Disclosures: Ahmed Shahatta indicated no relevant financial relationships. Hayder Alamily indicated no relevant financial relationships. Sana Rabeeah indicated no relevant financial relationships. Sajjad Al-Badri indicated no relevant financial relationships. Karrar Shakir indicated no relevant financial relationships. Ban Mashadani indicated no relevant financial relationships. Bisher Sawaf indicated no relevant financial relationships. Mohannad Bitar indicated no relevant financial relationships. Mushfiqur Siddique indicated no relevant financial relationships. Omer Najem indicated no relevant financial relationships. Abdulrahman Hamid indicated no relevant financial relationships. Omar Saab indicated no relevant financial relationships.
Ahmed Shahatta, MBChB1, Hayder Alamily, MD2, Sana Rabeeah, MD3, Sajjad Al-Badri, MBChB4, Karrar Shakir, MBChB5, Ban Mashadani, MD6, Bisher Sawaf, MD7, Mohannad Bitar, MD8, Mushfiqur Siddique, MD8, Omer Najem, MD9, Abdulrahman Khaldoon. Hamid, MD10, Omar Saab, MD11. P5640 - Invasive Gastric Mucormycosis Following SGLT2-Inhibitor-Induced Euglycemic DKA in a Patient With Poorly Controlled Diabetes Mellitus, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
