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

Mario Luiz Marques Piubelli; Aloisio Felipe-Silva; Marcia Yoshie Kanegae; Fernando Peixoto Ferraz de Campos

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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.


Necrosis, Esophagitis, Candidiasis, Invasive, Mycoses


Baehr PH, McDonald GB. Esophageal infections: risk factors, presentation, diagnosis, and treatment. Gastroenterology. 1994;106(2):509-32. 10.1016/0016-5085(94)90613-0.7980741

Al-Shawwa B, D’Andrea L, Quintero D. Candida esophageal perforation and esophagopleural fistula: a case report. J Med Case Rep. 2008;2(1):209. 10.1186/1752-1947-2-209.18559100

Gock M, Schäfer M, Perren A, Demartines N, Clavien PA. Fatal esophageal perforation caused by invasive candidiasis. Ann Thorac Surg. 2005;80(3):1120-2. 10.1016/j.athoracsur.2004.02.147.16122508

Underwood JA, Williams JW, Keate RF. Clinical findings and risk factors for Candida esophagitis in outpatients. Dis Esophagus. 2003;16(2):66-9. 10.1046/j.1442-2050.2003.00305.x.12823199

Gaissert HA, Breuer CK, Weissburg A, Mermel L. Surgical management of necrotizing Candida esophagitis. Ann Thorac Surg. 1999;67(1):231-3. 10.1016/S0003-4975(98)01144-8.10086557

Gaissert HA, Roper CL, Patterson GA, Grillo HC. Infectious necrotizing esophagitis: outcome after medical and surgical intervention. Ann Thorac Surg. 2003;75(2):342-7. 10.1016/S0003-4975(02)04343-6.12607636

Jones JM. Necrotizing Candida esophagitis: failure of symptoms and roentgenographic findings to reflect severity. JAMA. 1980;244(19):2190-1. 10.1001/jama.1980.03310190042020.7420723

Jones JM, Glass NR, Belzer FO. Fatal Candida esophagitis in two diabetics after renal transplantation. Arch Surg. 1982;117(4):499-501. 10.1001/archsurg.1982.01380280079016.7039554

Gurvits GE, Shapsis A, Lau N, Gualtieri N, Robilotti JG. Acute esophageal necrosis: a rare syndrome. J Gastroenterol. 2007;42(1):29-38. 10.1007/s00535-006-1974-z.17322991

Gurvits GE. Black esophagus: acute esophageal necrosis syndrome. World J Gastroenterol. 2010;16(26):3219-25. 10.3748/wjg.v16.i26.3219.20614476

Guarner J, Brandt ME. Histopathologic diagnosis of fungal infections in the 21st century. Clin Microbiol Rev. 2011;24(2):247-80. 10.1128/CMR.00053-10.21482725

Kim YH, Choi SY. Black esophagus with concomitant candidiasis developed after diabetic ketoacidosis. World J Gastroenterol. 2007;13(42):5662-3. 10.3748/wjg.v13.i42.5662.17948944

Ernst D, Baerlecken NT, Schmidt RE, Witte T. Large vessel vasculitis and spondyloarthritis: coincidence or associated diseases? Scand J Rheumatol. 2014;43(3):246-8. 10.3109/03009742.2013.850737.24438209

Ramos-Casals M, Brito-Zerón P, Muñoz S, et al. Autoimmune diseases induced by TNF-targeted therapies: analysis of 233 cases. Medicine. 2007;86(4):242-51. 10.1097/MD.0b013e3181441a68.17632266

Gillott TJ, Struthers GR. Cutaneous necrotizing vasculitis, erythema nodosum and ankylosing spondylitis. Rheumatology. 1999;38(4):377-8. 10.1093/rheumatology/38.4.377.10378721

Kobak S, Yilmaz H, Karaarslan A, Yalcin M. Leukocytoclastic vasculitis in a patient with ankylosing spondylitis. Case Rep Rheumatol. 2014;2014:653837. 10.1155/2014/653837.24653851

Machet L, Jan V, Ouakil H, Vaillant L, Estève E, Lorette G. Cutaneous leukocytoclastic vasculitis in a case of ankylosing spondylitis. Acta Derm Venereol. 1997;77(4):324.9228232

Taylan A, Yildiz Y, Sari I, Ozkok G. Vasculitis and long standing ankylosing spondylitis in a patient with familial Mediterranean fever. J Res Med Sci. 2014;19(10):1009-11.25538787

Beauvais C, Kaplan G, Mougenot B, Michel C, Marinho E. Cutaneous vasculitis and IgA glomerulonephritis in ankylosing spondylitis. Ann Rheum Dis. 1993;52(1):61-2. 10.1136/ard.




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