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Case Reports
. 2019 Mar 22;9(2):e2018070.
doi: 10.4322/acr.2018.070. eCollection 2019 Apr-Jun.

Fatal necrotizing Candida esophagitis in a patient with leukocytoclastic cutaneous vasculitis and ankylosing spondylitis

Mario Luiz Marques Piubelli  1 , Aloisio Felipe-Silva  1   2 , Marcia Yoshie Kanegae  3 , Fernando Peixoto Ferraz de Campos  3
Affiliations
Case Reports

Fatal necrotizing Candida esophagitis in a patient with leukocytoclastic cutaneous vasculitis and ankylosing spondylitis

Mario Luiz Marques Piubelli et al. Autops Case Rep. .

Abstract

Esophageal infection by Candida spp. is a common opportunistic entity in immunocompromised hosts; however, systemic fungal dissemination due to perforation or transmural necrosis, also known as necrotizing Candida esophagitis (NCE), is rare. We report the case of a 61-year-old male patient with diagnosed ankylosing spondylitis, severe arteriosclerosis, and vasculitis under immunosuppressive therapy who presented NCE with fungal and bacterial septicemia diagnosed at autopsy. Necrotizing esophagitis is a rare manifestation of Candida infection, which may be a final complication in severely ill patients. Unfortunately, it may be underdiagnosed, and we call attention to this devastating complication in patients with leukocytoclastic cutaneous vasculitis and ankylosing spondylitis.

Keywords: Candidiasis, Invasive; Esophagitis; Mycoses; Necrosis.

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Conflict of interest statement

Conflict of interest: None

Figures

Figure 1
Figure 1. Gross examination of the distal right ring-finger after amputation (A) and necrotic skin ulcers; B – Left ring finger; C – Left knee; D – left foot.
Figure 2
Figure 2. Photomicrograph of the skin biopsy showing mild lymphomononuclear pericapillary infiltrate with fibrinoid necrosis close to skin adnexa (H&E, 400X).
Figure 3
Figure 3. Photomicrograph of an area of aspiration pneumonia in the lung showing pseudohyphae of Candida spp. (Grocott, 400X).
Figure 4
Figure 4. Gross view of the esophagus showing mucosa with loosely adherent grayish pseudomembranes.
Figure 5
Figure 5. Gross aspect of abdominal cavity, showing peritoneal fibrinous exudate on the colonic surface.
Figure 6
Figure 6. A – Photomicrograph of the esophagus showing an active ulcer with inflammatory exudate (H&E, 100X); B – Coagulative necrosis of esophageal submucosa and vessels (H&E, 100X).
Figure 7
Figure 7. Photomicrograph of the esophagus showing invasive Candida spp. from mucosal ulcer and submucosa in A (Grocott; 100X) through adventitia; in B (yeasts in left bottom) (Grocott; 200X).
Figure 8
Figure 8. Photomicrograph of the peritoneum with exudative inflammation, pseudohyphae, and spores of Candida spp. (Grocott, 400x).
See this image and copyright information in PMC

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