Article in Japanese

A case of invasive mucormycosis and bacterial infection with multiple liver abscesses, gastric phlegmon, and subphrenic abscess ccomplicating diabetic ketoacidosis in a 2-year-old child

Yukitoshi Hanazawa^1）, Hiroshi Okada^1）

A previously healthy 2-year-old girl was hospitalized for new-onset diabetic ketoacidosis （DKA）. From hospital day 2, she developed rapidly progressive multiple organ failure requiring venoarterial extracorporeal membrane oxygenation （VA-ECMO） and mechanical ventilation. On day 19, increasing ascites were noted, accompanied by paralytic ileus and gastrointestinal bleeding. Contrast-enhanced computed tomography on day 21 showed multiple liver abscesses, phlegmonous gastritis, and large amounts of pleural and peritoneal effusions. Blood cultures, pleural fluid, ascites, and liver aspirates were all negative. Abdominal magnetic resonance imaging （MRI） subsequently revealed subphrenic abscess. Laparoscopic abscess drainage was performed on day 51, and specimens were analyzed concurrently using conventional culture and molecular testing. Rhizopus microsporus （order Mucorales） and Pseudomonas aeruginosa were identified by molecular analysis, prior to conventional culture, and on day 58, the antimicrobial agent was changed to piperacillin, and liposomal amphotericin B was started as an antifungal agent. It was speculated that the patient had developed secondary gastrointestinal mucormycosis, due to Rhizopus microsporus with concomitant bacterial infection during DKA treatment, against the background of type 1 diabetes. Children developing mucormycosis during new-onset DKA is rare and, to the authors’ knowledge, has not been reported in Japan. Identification of causative bacteria using genetic analysis was very useful.

---

1）Department of Pediatrics, Children’s Medical Center, Matsudo City General Hospital

Key words	mucormycosis, multiple liver abscesses, gastric phlegmon, type 1 diabetes mellitus, diabetic ketoacidosis
Received	November 22, 2025
Accepted	February 15, 2026

38 (2)：137─143,2026