Invasive candidiasis leading to gastric perforation in an immunocompromised patient

Abstract

Invasive candidiasis remains an important cause of mortality and morbidity in patients with underlying diseases. Here, we report a case of gastric perforation due to Candia glabrata infection in a 74-year-old-male with Paroxysmal nocturnal hemoglobinuria (PNH) who received long-term corticosteroid treatment of hemophagocytic syndrome associated with acute cholecystitis. Total gastrectomy was performed, and he was treated liposomal amphotericin B. The patient was extubated successfully on the 2nd postoperative day, but the patient died of Pneumocystis jirovecii pneumonia (PJP). An autopsy revealed that there was a small amount of the cystic form of Pneumocystic jirovecii , but there was not the presence of Candida spp . Concerning the prophylaxis of invasive candidiasis, there is no strong evidence-based data in clinical practice in immunocompromised patients, such as those receiving long-term immunomodulatory therapy or corticosteroids. Our present case suggests the importance of fungal management and may indicate the need for a new approach to the fungal prophylaxis in such patients.

Diagnosis and Treatment of Invasive Candidiasis

“…Special stainings, such as the periodic acid–Schiff stain, are capable of detecting polysaccarides and glycoproteins of the fungal cell wall; the Grocott–Gomori methenamine silver stain that targets carbohydrates is also used in histopathology [ 64 , 75 , 76 , 77 , 78 , 79 ]. The use of stains with fluorescent brighteners can increase sensitivity [ 27 ].…”

Candida Species Distribution of Clinical Specimens in Banda Aceh, Indonesia

“…Depending on the environmental conditions, the fungal pathogen is able to reversibly switch between two morphological forms as yeast-like form or filamentous form (pseudohyphae) contributing to the major virulence of the pathogen, including by means of biofilm formation (Tsui et al, 2016). Candidiasis predominantly affects individuals who have compromised immune status after administration of immunosuppressant drugs for the patients requiring organ transplantation or suffering from cancer (Sanguinetti et al, 2015;Karasuno et al, 2019).…”