P3967 - A Rare Case of Candida Esophagitis Complicated by Esophageal-Pleural Fistula in a Patient With Multiple Comorbidities

Mohamed Ismail, DO¹, Menna-Allah Elaskandrany, DO², David Kim, MD¹, Khaled Elsokary, DO³, Micheal Bebawy, DO¹, Mohamed Ghoniem, MS⁴, Yazan Abboud, MD¹, Ritik M. Goyal, MBBS¹, Esli Medina-Morales, MD¹, Shiva Kumar, MD⁵, Dhanasekaran Ramasamy, MD^6
1Rutgers New Jersey Medical School, Newark, NJ; ²Lenox Hill Hospital, Northwell Health, Astoria, NY; ³Albany Medical Center, Albany, NY; ⁴New York Institute of Technology College of Osteopathic Medicine, Roslyn, NY; ⁵Cleveland Clinic, Abu Dhabi, Abu Dhabi, United Arab Emirates; ⁶Cooperman Barnabas Medical Center, Union, NJ

Introduction: Invasive Candida esophagitis occurs predominantly in immunocompromised individuals, including those with HIV infection, transplant recipients and those undergoing chemotherapy. Commonly presenting with dysphagia and retrosternal pain, spontaneous esophageal perforation with esophageal-pleural fistula due to Esophageal Candidiasis is exceptionally rare. We present a case of spontaneous esophageal perforation due to Candidiasis in an immunocompromised patient, leading to esophageal-pleural fistula which was successfully treated with endoscopic assistance.

Case Description/Methods: A 68-year-old male with multiple comorbidities including HIV infection presented with progressive dyspnea, hypoxemia, and chest discomfort, He had been on antifungal therapy with fluconazole after recent diagnosis of Candida esophagitis based on endoscopic and histological findings.

Chest X-ray showed bilateral infiltrates and a large right-sided hydropneumothorax. CT scan revealed a fistulous connection between the esophagus and right pleural cavity (Figure-1), confirmed subsequently by a contrast esophagram. The patient underwent chest tube placement with initiation of mechanical ventilation due to worsening respiratory status. Broad-spectrum antibiotics and antifungal therapy using IV fluconazole were administered. Antibiotic therapy was tailored based on pleural fluid culture, that revealed methicillin-sensitive Staphylococcus and Enterococcus.

Following clinical stabilization, a self-expanding esophageal stent was placed under endoscopic and fluoroscopic guidance. His subsequent clinical course was characterized by gradual clinical improvement, permitting the removal of the chest tube. Follow-up esophagram confirmed the resolution of the esophageal-pleural fistula.

Discussion: Transmural invasive Candida infection with spontaneous esophageal perforation is an exceptionally rare complication of esophageal candidiasis with significant morbidity and mortality. Our case highlights the need to consider this rare, potentially life-threatening complication in immunocompromised patients presenting with atypical symptoms or those with known esophageal candidiasis not responding to antifungal therapy. Early recognition and prompt intervention could help limit morbidity and mortality associated with this life-threatening complication of esophageal candidiasis.



Disclosures:


Mohamed Ismail, DO¹, Menna-Allah Elaskandrany, DO², David Kim, MD¹, Khaled Elsokary, DO³, Micheal Bebawy, DO¹, Mohamed Ghoniem, MS⁴, Yazan Abboud, MD¹, Ritik M. Goyal, MBBS¹, Esli Medina-Morales, MD¹, Shiva Kumar, MD⁵, Dhanasekaran Ramasamy, MD⁶. P3967 - A Rare Case of <i>Candida</i> Esophagitis Complicated by Esophageal-Pleural Fistula in a Patient With Multiple Comorbidities, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.