[1627] 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.

Table 1. Demographic and Clinical Presentation

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

M = male, s/p = status post, 2° = secondary, GI = gastrointestinal


Conclusions: Invasive Candida infection may be a primary cause of ulceration and perforation of the jejunum. Few cases have been reported in the literature but it is likely to be an under-recognized as well as a rare entity.
Category: Infections

Wednesday, March 21, 2012 1:00 PM

Poster Session VI # 258, Wednesday Afternoon