[A case of intrabronchial dissemination of candida pseudohyphae presenting as respiratory failure]

A 63-year-old man was admitted to our hospital because of fever, skin eruption, leukocytopenia and liver dysfunction. He was receiving H2-blocker for gastric ulcer of the time he developed his symptoms. The H2-blocker was discontinued because of its possible association with leukocytopenia, and steroids were administered. On the 4th day of hospitalization, he suddenly developed expiratory wheeze and dyspnea, resembling an asthmatic attack. WBC was 400/mm3 with 65% neutrophils. Chest X-ray showed hyper inflation and increased thickness of bronchiolar walls. Bronchodilators had no effect and the patient died of respiratory failure on the 8th day. At autopsy, most bronchioles were filled with candida pseudohyphae. The large airways and lung parenchyma were not involved, except for focal bacterial pneumonia. Histological findings suggestive of bronchial asthma such as constriction of bronchial smooth muscle or infiltration of eosinophils were not observed Candida infection was also found in the pharynx, stomach, bowel, and kidneys. Candidiasis is becoming a more important contributory cause of death in compromised hosts. Although rare, this case suggests that patients with bronchopulmonary candidiasis present with expiratory wheeze resembling asthmatic attack.