Candidiasis of the Duodenum JJ e'unum

Infection of the small bowel with Candida species has previously been noted to occur in as many as 20% of autopsy cases with histologically demonstrated gastrointestinal candidiasis. Antemortem diagnosis, however, has been difficult and not previously reported. A renal transplant recipient presented with esophageal duodenal, and jejunal candidiasis, and the correct antemortem diagnosis of small bowel involvement was suggested by radiologic and endoscopic findings. Antifungal therapy resulted in complete resolution of these findings. Infections with opportunistic organisms, particularly fungi, are a common occurrence in renal transplant patients treated with immunosuppressive agents (1). The most frequently encountered fungal infections are due to Candida species (l,2), Candida albicans being the most common organism. Several reports suggest that mucosal infections, genitourinary tract infections, and draining wounds may serve as sources for candidemia and deepseated infections (2,3). Mucosal lesions in the gastrointestinal tract predominantly involve the esophagus (4), and such cases may be diagnosed endoscopically with relative ease (5). Gastric and duodenal candidal lesions, which are less frequent, have only uncommonly been detected antemortem (6). Small bowel lesions of candidiasis, however, have only been reported previously in autopsy cases (4). Here, we report the case of a renal transplant recipient who had esophageal, duodenal, and jejunal involvement. The correct diagnosis was suggested by radiographic and endoscopic abnormalities described herein.