Open AccessRefractory hemorrhagic esophageal ulcers by Candida esophagitis with advanced systemic sclerosis
Author(s) -
Natsui Kazuki,
Tsuchiya Atsunori,
Terai Shuji
Publication year - 2020
Publication title -
jgh open
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.546
H-Index - 8
ISSN - 2397-9070
DOI - 10.1002/jgh3.12353
Subject(s) - medicine , esophageal ulcer , esophagogastroduodenoscopy , esophagitis , reflux esophagitis , abatacept , gastroenterology , rheumatoid arthritis , scleroderma (fungus) , esophageal candidiasis , endoscopy , surgery , dermatology , esophagus , disease , reflux , human immunodeficiency virus (hiv) , immunology , rituximab , lymphoma , viral disease , inoculation
A 64‐year‐old woman diagnosed with rheumatoid arthritis (RA) and systemic sclerosis (SSc) was admitted to our hospital with chief complaints of uncontrolled bleeding from esophageal ulcers and an inability to consume meals. For RA and SSc, she was treated with prednisolone and abatacept and was taking vonoprazan as prophylaxis for steroid‐induced gastric ulcers. She was diagnosed with severe Candida esophagitis, with multiple large and small ulcers with bleeding, based on esophagogastroduodenoscopy and pathological findings. We performed comprehensive treatment; abatacept was discontinued, and total parenteral nutrition was initiated along with antifungal therapy. Improvement in the esophageal ulcers was observed. Although severe Candida esophagitis is a rare condition, we should keep in mind that severe Candida esophagitis can occur in patients with an immunosuppressive compromised host and esophageal movement disorders such as SSc. Regular follow up by endoscopy and prophylactic treatment to prevent severe esophagitis may be necessary.