The role of panfungal polymerase chain reaction (PCR) assays for diagnosis of invasive fungal disease (IFD) is inadequately defined. We describe the use of an internal transcribed spacer 1 (ITS-1) region-directed panfungal PCR in this context at a tertiary referral transplant center. A retrospective review of patients at Alfred Health, Melbourne, Australia (2009-2014) who had clinical samples referred for panfungal PCR testing was conducted. Baseline patient characteristics, antifungal drug history, fungal culture/histopathology, and radiology results were recorded. For bronchoalveolar lavage (BAL) fluid samples, identification of a fungus other than a Candida spp. was defined as a potential pathogen.Of 138 panfungal PCR tests (108 patients), 41 (30%) were positive for a fungal product. Ninety-seven percent (134/138) of specimens were from immunocompromised hosts. Thirteen percent (19/138) of panfungal PCR positive results were for potential pathogens and potential pathogens were detected more frequently in tissue as compared with BAL (12/13 vs. 6/26; P = .0001). No positive panfungal PCR results were obtained from CSF specimens. If histopathology examination was negative, panfungal PCR identified a potential pathogen in only 12% (11/94) of specimens. For the 20 culture negative/histopathology positive specimens, diagnosis of IFD to causative species level by panfungal PCR occurred in 35% (6/20).Sterile site specimens, in particular tissue, were more frequently panfungal PCR positive for potential pathogens than BAL. The utility of panfungal PCR appears greatest in tissue specimens, as an adjunct to histopathology to improve diagnostic sensitivity and specificity. Based on the results of this study we are now only testing tissue specimens by panfungal PCR.

No abstract

Syndrome in view of persistent symptoms. Her gastrin level came back elevated at 4,180 pg/ml after her medications were stopped to get the correct lab readings. A nuclear scan was scheduled for the patient to localize the gastrinoma lesion, but suddenly the patient became altered, hypotensive, and developed an acute abdomen. On further investigation with CT scan of the abdomen, patient was found to have pneumoperitoneum, secondary to bowel perforation. She underwent an emergent exploratory laparotomy, was found to have large perforations of the 3rd, 4th portion of the duodenum and several small perforations throughout the small bowel. A Para duodenal lymph node was taken and sent for pathology. Pathology revealed a well-differentiated neuroendocrine tumor: histological subtype gastrinoma. The patient underwent duodenal resection, gastrojejunostomy, cholecystectomy and feeding tube placement. Post-op period was complicated by patient having persistent dysphagia, initially to solids and progressed to have dysphagia to liquids as well. The patient underwent an EGD again which showed presence of esophageal stricture and had to undergo dilatation 6 times in a span of 2 months for symptom relief. She follows up with oncology and gastroenterology regularly and is scheduled to get a PET scan soon to rule out metastasis. (Figure ) Discussion: Gastrinomas manifest with peptic ulcer disease symptoms but some patients present with diarrhea. Serum gastrin levels of . 1000 pg/ml with symptoms is diagnostic of gastrinoma. A secretin provocative test is used for diagnosis if gastrin levels are , 1000 pg/ml. As clinicians, we must be aware of the complications of gastrinoma.