Article: A rare case report of fungal esophagitis combined with giant gastric ulcer in an immunocompetent patient

Rationale: Fungal infection of gastrointestinal (GI) tract is usually seen in immunocompromised patients, but can rarely occur in immunocompetent people in whom no permissive factor is present.

Patient Concerns: We describe a 68-year-old male immunocompetent patient presenting with simultaneous fungal esophagitis and giant gastric ulcer.

Diagnoses: Repeated endoscopic biopsies were taken from the giant gastric ulcer edge and base and histology demonstrated granulation tissue and pseudohyphal fungal forms.

Interventions: The patient was treated with fluconazole and omeprazole for 8 weeks.

Outcomes: After antifungal treatment with fluconazole, the patient's clinical symptoms gradually disappeared with the healing of gastric ulcer, which never recurred in this patient until 3 months after follow-up.

Lessons: Nonhealing gastroesophageal ulcers highlights the importance of repeated endoscopies and biopsies.

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References

1.

Rai P, Chakraborty S . Giant fungal gastric ulcer in an immunocompetent individual. Saudi J Gastroenterol. 2012; 18(4):282-4. PMC: 3409891. DOI: 10.4103/1319-3767.98438. View

2.

Jin L, Yoshida M, Nakamura T, Ishikawa H, Wakabayashi G, Tanabe M . Candida albicans infection delays duodenal ulcer healing in cysteamine-induced duodenal ulcers in rats. Dig Dis Sci. 2008; 53(11):2878-85. DOI: 10.1007/s10620-008-0385-9. View

3.

Wu C, Wu S, Chen P . A prospective study of fungal infection of gastric ulcers: clinical significance and correlation with medical treatment. Gastrointest Endosc. 1995; 42(1):56-8. DOI: 10.1016/s0016-5107(95)70244-x. View

4.

Minoli G, Terruzzi V, Butti G, Benvenuti C, Rossini T, Rossini A . A prospective study on Candida as a gastric opportunistic germ. Digestion. 1982; 25(4):230-5. DOI: 10.1159/000198837. View

5.

Zwolinska-Wcislo M, Budak A, Bogdal J, Trojanowska D, Stachura J . Fungal colonization of gastric mucosa and its clinical relevance. Med Sci Monit. 2001; 7(5):982-8. View

6.

Bonacini M, Young T, Laine L . The causes of esophageal symptoms in human immunodeficiency virus infection. A prospective study of 110 patients. Arch Intern Med. 1991; 151(8):1567-72. View

7.

Badarinarayanan G, Gowrisankar R, Muthulakshmi K . Esophageal candidiasis in non-immune suppressed patients in a semi-urban town, southern India. Mycopathologia. 2001; 149(1):1-4. DOI: 10.1023/a:1007245919761. View

8.

Nassar Y, Eljabbour T, Lee H, Batool A . Possible Risk Factors for Candida Esophagitis in Immunocompetent Individuals. Gastroenterology Res. 2018; 11(3):195-199. PMC: 5997470. DOI: 10.14740/gr1019w. View

9.

Rajablou M, Ganz R, Batts K . Candida infection presenting as multiple ulcerated masses. Gastrointest Endosc. 2006; 65(1):164-6. DOI: 10.1016/j.gie.2006.05.024. View

10.

Saeed A, Assiri A, Zaidi Z, Alsheikh A . Fungal Esophagitis in a Child with Insulin Dependent Diabetes Mellitus. J Coll Physicians Surg Pak. 2016; 26(8):712-3. DOI: 2413. View

11.

Knoke M, Bernhardt H . Endoscopic aspects of mycosis in the upper digestive tract. Endoscopy. 1980; 12(6):295-8. DOI: 10.1055/s-2007-1021763. View

12.

Zwolinska-Wcislo M, Budak A, Bogdal J, Trojanowska D, Stachura J . Effect of fungal colonization of gastric mucosa on the course of gastric ulcers healing. Med Sci Monit. 2001; 7(2):266-75. View

A Rare Case Report of Fungal Esophagitis Combined with Giant Gastric Ulcer in an Immunocompetent Patient