RESUMEN
RATIONALE: Mucormycosis is a rare opportunistic fungal infection with poor prognosis. The incidence of mucormycosis has been increasing, and it is a threat to immunocompromised hosts. We present a case of gastric mucormycosis complicated by a gastropleural fistula during immunosuppressive treatment for adult-onset Still disease (AOSD). PATIENT CONCERNS: An 82-year-old woman diagnosed with AOSD who developed gastric ulcers during the administration of an immunosuppressive therapy with corticosteroids, cyclosporine, and tocilizumab complained of melena and epigastralgia. Esophagogastroduodenoscopy showed multiple ulcers covered with grayish or greenish exudates. DIAGNOSES: The patient diagnosed with mucormycosis based on culture and biopsy of the ulcers, which showed nonseptate hyphae branching at wide angles. Mucor indicus was identified using polymerase chain reaction. INTERVENTIONS AND OUTCOMES: Although liposomal amphotericin B was administered, gastric mucormycosis was found to be complicated by a gastropleural fistula. The patient died because of pneumonia due to cytomegalovirus infection, and autopsy revealed the presence of Mucorales around the fistula connecting the stomach and diaphragm. LESSONS: Gastric mucormycosis is refractory to treatment and fatal. Surgical resection, if possible, along with antifungal drugs can result in better outcomes.
Asunto(s)
Fístula Gástrica/microbiología , Mucormicosis/complicaciones , Infecciones Oportunistas/complicaciones , Fístula del Sistema Respiratorio/microbiología , Úlcera Gástrica/microbiología , Anciano de 80 o más Años , Femenino , Fístula Gástrica/inducido químicamente , Humanos , Inmunosupresores/efectos adversos , Mucormicosis/inducido químicamente , Mucormicosis/microbiología , Infecciones Oportunistas/inducido químicamente , Infecciones Oportunistas/microbiología , Pleura/microbiología , Fístula del Sistema Respiratorio/inducido químicamente , Enfermedad de Still del Adulto/tratamiento farmacológico , Úlcera Gástrica/inducido químicamenteAsunto(s)
Absceso Abdominal/microbiología , Burkholderia pseudomallei/aislamiento & purificación , Fístula Gástrica/microbiología , Melioidosis/microbiología , Enfermedades del Bazo/microbiología , Absceso Abdominal/diagnóstico , Absceso Abdominal/terapia , Antibacterianos/administración & dosificación , Ceftazidima/administración & dosificación , Drenaje , Fístula Gástrica/diagnóstico , Fístula Gástrica/terapia , Gastroscopía , Humanos , Masculino , Melioidosis/complicaciones , Melioidosis/diagnóstico , Melioidosis/terapia , Persona de Mediana Edad , Esplenectomía , Enfermedades del Bazo/diagnóstico , Enfermedades del Bazo/terapia , Tomografía Computarizada por Rayos X , Resultado del TratamientoAsunto(s)
Candidiasis/complicaciones , Gastrectomía/efectos adversos , Fístula Gástrica/etiología , Laparoscopía/efectos adversos , Obesidad Mórbida/cirugía , Adulto , Antifúngicos/uso terapéutico , Líquido Ascítico/microbiología , Candida/aislamiento & purificación , Candidiasis/tratamiento farmacológico , Candidiasis/microbiología , Femenino , Fluconazol/uso terapéutico , Fístula Gástrica/microbiología , Humanos , Masculino , Persona de Mediana Edad , Obesidad Mórbida/complicacionesAsunto(s)
Fístula Gástrica/microbiología , Giardiasis/complicaciones , Infecciones por Helicobacter/complicaciones , Helicobacter pylori , Úlcera Péptica Hemorrágica/microbiología , Anciano , Femenino , Fístula Gástrica/parasitología , Gastroscopía , Giardiasis/tratamiento farmacológico , Infecciones por Helicobacter/tratamiento farmacológico , HumanosAsunto(s)
Fístula Gástrica/diagnóstico , Fístula Intestinal/diagnóstico , Píloro/patología , Dolor Abdominal/tratamiento farmacológico , Dolor Abdominal/etiología , Antibacterianos/uso terapéutico , Fístula Gástrica/microbiología , Fístula Gástrica/patología , Gastroscopía , Helicobacter/aislamiento & purificación , Humanos , Fístula Intestinal/microbiología , Fístula Intestinal/patología , Masculino , Persona de Mediana Edad , Inhibidores de la Bomba de Protones/uso terapéutico , Antro Pilórico/microbiología , Antro Pilórico/patología , Píloro/microbiologíaRESUMEN
BACKGROUND: Empyema due to Candida species is a rare entity, and the significance of isolation of Candida species from the pleural effusion is not fully understood. OBJECTIVE: To elucidate the clinical features of Candida empyema. METHODS: We retrospectively reviewed the cases of 128 patients with culture-positive empyema. RESULTS: These 128 patients included 7 whose cause of empyema was esophago- or gastropleural fistula. Empyema was due to Candida species in 5 of the 7 patients. Primary diseases of these 5 patients were spontaneous esophageal rupture in 3 patients, esophageal rupture due to lung cancer invasion in 1 patient, and gastric ulcer perforation in 1 patient. None of these 5 patients had esophageal candidiasis. Among the 121 other patients with empyema not due to esophago- or gastropleural fistula, no patient had empyema due to Candida. CONCLUSION: We believe that the empyema in these 5 patients was caused by normal commensal Candida species entering the pleural cavity when the fistula between the gastrointestinal tract and pleural cavity was formed. Isolation of Candida species can be an important clue for suspecting gastrointestinal tract perforation as a cause of empyema.
