Emmanuel McDonald, DO1, Marisol Trejoss2, David Choi, DO2, Linoj Panicker, DO2, Odayls Frontela, MD1, Javier Sobrado, MD2
1Larkin Community Hospital - Palm Springs, Miami, FL; 2Larkin Community Hospital, Miami, FL
Esophageal candidiasis (EC) is one of the most common infections in immunocompromised individuals. Fungal infections, particularly in the esophagus, have been found in individuals with predisposing factors, such as uncontrolled diabetes mellitus, gastric acid suppression, malignant neoplasms, corticosteroids, antibiotics, or immunosuppressant use. Factors that suppress cellular immunity often cause opportunistic fungal infections; however, little is known regarding significant risk factors in individuals who are immunocompetent. For our study, we report a rare and unusual case of a 58 year old immunocompetent male who presented with recurrent esophageal candidiasis.
EC is not a rare complication for individuals who are immune compromised or who are uncontrolled diabetics; however, our case is unique and rare because our patient did not have the typical comorbidities associated with esophageal candidiasis. The patient had a PMHx of well-controlled DM type 2, HIV (-), diet controlled GERD who is not taking PPI therapy who presented with a 20 pound weight loss and dysphagia to solids. An EGD revealed a benign gastric mass and esophageal candida, then treated with Fluconazole. After completion of therapy, he returned with dysphagia, abdominal pain, weakness, and weight loss, requiring hospitalization. A repeat EGD revealed a second EC infection, this one an ulcerated EC infection, which was treated with IV Fluconazole. On outpatient follow up after discharge, the patient underwent CT scan of abdomen/pelvis. It showed moderately thickened and dilated esophageal walls, bullae, and migration of the stent into the stomach which had been placed previously. Additional findings on imaging include, bilateral renal masses, left para-aortic adenopathy, and loculated fluid collection in the abdomen. Consequently, the patient underwent another EGD to remove the stent and was sent to Oncology for further care.
Our patient’s clinical manifestations, initial findings, and developmental course of the presenting illness in this patient makes this case particularly rare and unusual in terms of assessment and diagnosis. EC in an immunocompetent patient is rare; however, recurrent EC is even rarer. At this time there is limited data reported on attributable causes of EC, especially in individuals without predisposing factors. Thus, this case highlights the need for further investigation regarding the mechanisms of colonization and its development in such individuals are needed.
Citation: Emmanuel McDonald, DO; Marisol Trejoss; David Choi, DO; Linoj Panicker, DO; Odayls Frontela, MD; Javier Sobrado, MD. P0316 - A TOUGH PILL TO SWALLOW: A RARE AND UNUSUAL CASE OF RECURRENT ESOPHAGEAL CANDIDIASIS. Program No. P0316. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.