25-09-2024 | Esophagitis | Images in clinical gastroenterology
A case of gastric candidiasis in a patient with cirrhosis
Published in: Indian Journal of Gastroenterology
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A 54-year-old lady diagnosed with metabolic dysfunction-associated steatohepatitis (MASH)-related decompensated cirrhosis (ascites and recurrent hepatic encephalopathy) presented with melena. Routine investigation showed hemoglobin 10.1 gm/dL, white blood cell count − 13,560/mm3, platelet count − 15,1000/mm3, bilirubin 0.80 mg/dL and albumin 2.40 gm/dL. There was no history of long-term proton pump inhibitor (PPI) intake and was negative for retrovirus. She underwent esophagogastroscopy that revealed several shallow black ulcerated lesions averaging 7–8 mm in size in the fundus and body of stomach and small esophageal varies. Most of the ulcers showed black pigmentation (Fig. 1). Multiple biopsies were taken from the ulcer edges which revealed chronic inflammatory infiltrate in the lamina propria with focal cryptitis and clusters of yeast-like and pseudo-hyphal forms of Candida albicans (Fig. 2). Blood culture was sterile. She was treated with fluconazole (200 mg for 14 days). Repeat esphagogastroscopy done after 21 days showed the resolution of ulcers.
Fig. 1
a Endoscopic photograph showing multiple black color ulcers noted along the greater and lesser curvature of the upper gastric body. b Endoscopic photograph showing resolution of the ulcers that was previously noted along the greater and lesser curvature of the upper gastric body
Fig. 2
Light microscopic view of the biopsied specimen from the ulcer. a hematoxylin and eosin (H&E) staining. × 100. b Gomori methenamine-silver staining. × 100 showing budding yeast with innumerable hyphae in the ulcer slough
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