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Author Spotlight: Generation of and Comparison Between Patient-Derived Gastric Organoids from Different Regions of the Stomach
Published on: January 26, 2024
Invasive candidiasis leading to gastric perforation in an immunocompromised patient
Takahiro Karasuno1, Hiroshi Sata1, Yuri Noda2
1Department of Hematology, Rinku General Medical Center, Japan.
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.
Insights
Invasive candidiasis, a serious fungal infection, caused gastric perforation in an immunocompromised patient. This case highlights the need for better antifungal prophylaxis strategies in vulnerable individuals.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Critical Care Medicine
Background:
- Invasive candidiasis is a significant threat in immunocompromised patients.
- Long-term corticosteroid therapy for conditions like hemophagocytic syndrome increases fungal infection risk.
- Paroxysmal nocturnal hemoglobinuria (PNH) patients may face unique infectious challenges.
Observation:
- A 74-year-old male with PNH on corticosteroids developed gastric perforation due to Candida glabrata.
- The patient underwent total gastrectomy and received liposomal amphotericin B.
- Postoperatively, the patient succumbed to Pneumocystis jirovecii pneumonia (PJP).
Findings:
- Autopsy confirmed PJP but found no evidence of Candida species.
- The case underscores the complexity of managing opportunistic infections in severely ill patients.
- Current guidelines lack robust evidence for invasive candidiasis prophylaxis in this population.
Implications:
- This case emphasizes the critical need for proactive fungal management in immunocompromised patients.
- It suggests a potential gap in current antifungal prophylaxis strategies.
- Further research is warranted to develop evidence-based approaches for preventing invasive fungal infections.
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