2724 Systemic Fungemia Following Gastric Ulcer Perforation in a Patient With Hepatocellular Carcinoma: A Case Report and Review of Literature

Abstract

INTRODUCTION: The frequent overgrowth of Candida in the intestinal microbiota has made candidemia one of the most common bloodstream infections in the United States. Such infections are capable of infecting organs leading to several threatening conditions such as fungal endocarditis, meningitis, osteomyelitis, or Candida endophthalmitis. In rare occurrences, Candida species overgrowth has also been theorized to promote perforations of gastric ulcers. CASE DESCRIPTION/METHODS: We are reporting the case of a 56-year-old immunocompromised male with a history of cirrhosis of liver secondary to Hepatitis C, hepatocellular carcinoma and gastric ulcers who presented with generalized abdominal pain and distention. Physical exam showed him to be in moderate distress with diffuse severe tenderness to palpation with guarding and rebound tenderness. A CT of the abdomen revealed pneumoperitoneum, and a subsequent diagnostic laparoscopy discovered a 5 mm gastric ulcer perforation with an opening into the antrum of the stomach. Following surgical repair of the perforation, blood and peritoneal fluid cultures revealed the growth of Candida galbrata. Despite aggressive antifungal therapy, the patient expired due to multisystem organ failure. DISCUSSION: While most gastric perforations are caused by complications with peptic ulcer disease, nonsteroidal anti-inflammatory drugs, or certain neoplasms, studies have shown that Candida overgrowth may also promote the perforation of a pre-existing ulcer. Fungal overgrowth most frequently occurs in immunocompromised patients or those on certain medications. Patients with a Candida infection are at an increased risk for organ failure, surgical site infections, a prolonged hospitalization, and a significantly higher mortality rate.