Fatal Candida esophagitis in two diabetics after renal transplantation

Severe necrotizing Candida esophagitis developed in two insulin-dependent diabetics after they received renal allografts. In each patient, the infection led to a perforation of the esophagus and was ultimately fatal despite aggressive medical and surgical management. The frequency and severity of Candida esophagitis seems to be higher in diabetics rather than in nondiabetic patients who received renal transplants. In these two diabetic transplant recipients, small doses of oral nystatin did not prevent Candida esophagitis. Appropriate diagnostic tests must be performed promptly when symptoms of odynophagia or dysphagia develop in these patients. In diabetic transplant recipients with documented candidiasis, decreased symptoms of esophagitis should not be relied on to indicate a response to therapy. Discontinuation of immunosuppressive drugs, as well as aggressive treatment with oral and parenterally absorbed antifungal agents, offer the best hope for preventing severe morbidity or mortality from the infection in these patients.