Invasive Candidiasis Associated with Jejunal Ulceration and Perforation: An Under-Recognized Entity? Report of Three Cases
Josenia NM Tan, Michael J O'Brien, Nancy S Miller, Huihong Xu. Boston University Medical Center, Boston, MA
Background: Candida species, a known colonizer of mucus membranes also has the ability to colonize and invade host cells and tissues to cause infection. The most susceptible patient groups include the immunocompromised, neutropenic patients, low birth weight infants and neonates with severe gastrointestinal diseases. More recent reports suggest association with certain diets and medications such as H2 blockers. A recent case of small bowel ulceration and perforation with invasive candidiasis prompted us to review previous cases of small bowel perforation at our institution.
Design: A restrospective review of all surgical cases of small bowel perforations received at Boston Medical Center from January 1, 2001 to September 30, 2011 was performed. Total of 44 cases were identified; the majority were secondary to trauma (43%), idiopathic causes (30%) and malignancy (9%). Less frequent causes were ischemic enteritis (5%), diverticulosis (5%) and foreign body (2%). Three cases of small bowel perforations (7%) were found associated with invasive Candida infection. Histological sections of the involved bowel segments, special stains (PAS and GMS), and microbiology culture results were reviewed.
Results: Histopathology of the segments of resected small bowel in all 3 patients showed invasive Candida enteritis with ulceration and perforation. All underwent exploratory laparotomy where perforation of the jejunum was found. The specific organisms subsequently grown in the abdominal drainage/peritoneal fluid sent for culture were Candida albicans, Candida tropicalis and Candida glabrata respectively, with all three organisms present in one case. No other etiology for the perforation was identified and none were immunosuppressed.
|Case||Age/Gender||Associated Condition||Presentation||Site of Perforation|
|1||52/M||Gastrinoma||Acute abdominal pain||Jejunum|
|2||64/M||s/p Splenectomy 2° trauma||Small bowel obstruction||Jejunum|
|3||52/M||Liver Failure, Hepatitis C cirrhosis, Portal Vein Thrombosis, Anemia||GI bleed||Jejunum|