Abstract
Background Small bowel transplantation is a potential option for patients with intestinal-failure, and the incidences of infections caused by Candida species that are more resistant to antifungal drugs are increasing in these patients. In this manuscript, we reported a case of fatal colitis after small bowel transplantation induces by multidrug-resistant (MDR) Candida glabrata. Case Presentation. A 52-year-old man has undergone an extensive small bowel resection with the length of the remaining bowel which was less than 40 cm who became a candidate for transplantation. Four months after transplantation, the patient experienced severe bloody diarrhea with abdominal distension. Ileoscopy and colonoscopy did not show neither pathological change and rejection nor cytomegalovirus (CMV) infection posttransplantation. Abdomen computed tomography showed diffuse moderate small bowel wall thickening. After detection of budding yeast in the stool samples, stool culture was positive for Candida, DNA was extracted, and ITS1-5.8s-ITS2 region of the fungal agent was amplified. Sequencing analysis of PCR and antifungal susceptibility testing revealed that this isolate was multidrug-resistant C. glabrata. Besides, there was no evidence for other pathogens known to cause infection in various laboratory tests. Immediate antifungal treatments with caspofungin remained unsuccessful, and on the eighteenth day of admission, the patient expires with septic shock. Conclusion These findings highlight the challenging management of candidiasis in patients with small bowel transplantation. Infectious diseases due to MDR organisms have emerged as a vital clinical problem in this patient population.
Highlights
Small bowel transplantation is a potential option for patients with intestinal-failure, and the incidences of infections caused by Candida species that are more resistant to antifungal drugs are increasing in these patients
Over the last twenty years, intestinal transplantation has been performed for the treatment of patients with intestinal failure and the incidence of fungal infections is higher among patients receiving ISTx than other solid organ transplant (SOT) because these patients have a central catheter for a long time to receive total parenteral nutrition and broad-spectrum antibiotics and due to loss of intestinal mucosal integrity during recovery, preservation, and transplantation [12, 14]
Candidiasis as the most cases of nosocomial infection in intestinal transplantation recipients Candida spp. is the most common cause of infection among intestinal transplant patients, which has a role of non-C. albicans spp., including C. glabrata which is higher than other species of Candida genus
Summary
Infections remain a major cause of morbidity and mortality among solid organ transplant (SOT) recipients. Candida spp. are the most common type of fungal infections among SOT recipients except for lung transplant recipients in which Aspergillus is more prevalent [2, 8]. Whereas Candida albicans has been the most common species isolated from IFIs, there is a steady increase in fungal infections caused by non-albicans Candida species [8, 9]. The emergence of multidrug-resistant Candida glabrata, during prolonged and more broad-spectrum exposure to antifungal agents have created a therapeutic challenge [10]. In this manuscript, we reported fatal severe colitis after isolated small bowel transplantation induces by MDR C. glabrata
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