CID 1992; 15 (September)
Correspondence
555
Colitis Due to Candida albicans in a Patient with AIDS
Figure 1. Nodular lesions involving superior and inferior aspects of the distal transverse colon.
Several days later the patient suffered a cardiorespiratory arrest and could not be resuscitated. An autopsy was performed; histopathology and cultures revealed no evidence of CMV but rather extensive, invasive colitis due to C. albicans in association with disseminated candidiasis. Multifocal, deep-tissue involvement with invasive yeast forms was noted microscopically throughout the colonic mucosa and the mucosae of the esophagus, stomach, small intestine, liver, and spleen; in the abdominal, mediastinal, hilar, and cervical lymph nodes; and in the lungs, thyroid, adrenal glands, testes, and kidneys. Colitis due to Candida species in patients with neoplastic diseases [I] and in a renal transplant recipient [2] has previously been reported. Among 22 patients with cancer and candidal colitis in one series, 17 had lesions that appeared to be ulcers or erosions [I]. This case illustrates that C. albicans can produce colitis with the appearance of multiple colonic ulcers in a patient infected with HIV-I. Such colitis may be associated with disseminated candidiasis.
Sharada Jayagopal and Joseph S. Cervia Departments of Radiology and Internal Medicine. Nassau County Medical Center. East Meadow. New York References
Correspondence: Dr. Joseph S. Cervia, Department of Medicine. Division of Infectious Diseases. Nassau County Medical Center. 220 I Hempstead Turnpike. East Meadow. New York 11554.
Clinical Infectious Diseases 1992;15:555 © 1992 by The University of Chicago. All rights reserved.
1058-4838/92/1503-0027$02.00
I. Erias P. Goldstein MJ. Sherlock P. Candida infection of the gastrointestinal tract. Medicine (Baltimore) 1972;51:367-79. 2. Stylianos S. Forde KA. Benvenisty AI, Hardy MA. Lower gastrointestinal hemorrhage in renal transplant recipients. Arch Surg 1988; 123:739-44.
Downloaded from http://cid.oxfordjournals.org/ at University of Sussex on July 22, 2015
SIR-Despite the frequency with which Candida albicans has been found to produce oral thrush and esophagitis in patients infected with human immunodeficiency virus type I (HIV-I), we report, to our knowledge, the first case of primary colitis due to C. albicans in such a patient. A 38-year-old bisexual Ecuadorian man who had lived in the United States for the past 6 years was found to be HIV seropositive 2 years before admission. The patient's absolute CD4 cell count was 52/mm 3; however, he had no prior history of'opportunistic infection and had been receiving therapy with zidovudine until 4 months before admission, when it had been discontinued because of severe anemia. He had also been taking trimethoprim-sulfamethoxazole as prophylaxis for pneumonia due to Pneumocystis carinii. He was admitted to the hospital with a 3-month history of watery diarrhea accompanied by vague abdominal pain; he had also lost 30 lb. His stools contained no gross blood or mucus. The patient admitted that he had been having some difficulty swallowing recently. On examination the patient was noted to have a temperature of 101°F, oral thrush, and a 15-cm liver span. A guaiac test of his stool was negative. Laboratory findings included the following pertinent values: white blood cell count, 3,800/mm 3 ; hemoglobin, 8.3 g/dL; albumin, 2.6 g/dl.; total protein, 7.7 g/dl.; total bilirubin, 0.3 mg/dl.; alkaline phosphatase, 328 U/L; aspartate aminotransferase, 131 U/L; alanine aminotransferase, 178 U/L; and glutamyl transpeptidase, 113 U /L. Results ofstool cultures and ofevaluations for ova and parasites and Clostridium difficile toxin were negative. Therapy with zidovudine was restarted. Therapy with ketoconazole was begun for treating the patient's thrush and possible esophagitis. The patient underwent a barium enema that revealed multiple nodular and polypoid masses involving the sigmoid, descending, and transverse colon (figure I) as well as the ascending colon and cecum. No reflux into the terminal ileum was demonstrated, and the patient refused any further maneuvers. The colon otherwise was noted to have normal caliber and haustral markings. A colonoscopy was then performed. Multiple ulcers of varying size with heaped up edges and necrotic bases were seen throughout the colon; multiple biopsy specimens were taken. Clinical and histopathologic findings were considered to be consistent with colitis due to cytomegalovirus (CMV), and the patient began receiving iv ganciclovir.
Correspondence
555
Colitis Due to Candida albicans in a Patient with AIDS
Figure 1. Nodular lesions involving superior and inferior aspects of the distal transverse colon.
Several days later the patient suffered a cardiorespiratory arrest and could not be resuscitated. An autopsy was performed; histopathology and cultures revealed no evidence of CMV but rather extensive, invasive colitis due to C. albicans in association with disseminated candidiasis. Multifocal, deep-tissue involvement with invasive yeast forms was noted microscopically throughout the colonic mucosa and the mucosae of the esophagus, stomach, small intestine, liver, and spleen; in the abdominal, mediastinal, hilar, and cervical lymph nodes; and in the lungs, thyroid, adrenal glands, testes, and kidneys. Colitis due to Candida species in patients with neoplastic diseases [I] and in a renal transplant recipient [2] has previously been reported. Among 22 patients with cancer and candidal colitis in one series, 17 had lesions that appeared to be ulcers or erosions [I]. This case illustrates that C. albicans can produce colitis with the appearance of multiple colonic ulcers in a patient infected with HIV-I. Such colitis may be associated with disseminated candidiasis.
Sharada Jayagopal and Joseph S. Cervia Departments of Radiology and Internal Medicine. Nassau County Medical Center. East Meadow. New York References
Correspondence: Dr. Joseph S. Cervia, Department of Medicine. Division of Infectious Diseases. Nassau County Medical Center. 220 I Hempstead Turnpike. East Meadow. New York 11554.
Clinical Infectious Diseases 1992;15:555 © 1992 by The University of Chicago. All rights reserved.
1058-4838/92/1503-0027$02.00
I. Erias P. Goldstein MJ. Sherlock P. Candida infection of the gastrointestinal tract. Medicine (Baltimore) 1972;51:367-79. 2. Stylianos S. Forde KA. Benvenisty AI, Hardy MA. Lower gastrointestinal hemorrhage in renal transplant recipients. Arch Surg 1988; 123:739-44.
Downloaded from http://cid.oxfordjournals.org/ at University of Sussex on July 22, 2015
SIR-Despite the frequency with which Candida albicans has been found to produce oral thrush and esophagitis in patients infected with human immunodeficiency virus type I (HIV-I), we report, to our knowledge, the first case of primary colitis due to C. albicans in such a patient. A 38-year-old bisexual Ecuadorian man who had lived in the United States for the past 6 years was found to be HIV seropositive 2 years before admission. The patient's absolute CD4 cell count was 52/mm 3; however, he had no prior history of'opportunistic infection and had been receiving therapy with zidovudine until 4 months before admission, when it had been discontinued because of severe anemia. He had also been taking trimethoprim-sulfamethoxazole as prophylaxis for pneumonia due to Pneumocystis carinii. He was admitted to the hospital with a 3-month history of watery diarrhea accompanied by vague abdominal pain; he had also lost 30 lb. His stools contained no gross blood or mucus. The patient admitted that he had been having some difficulty swallowing recently. On examination the patient was noted to have a temperature of 101°F, oral thrush, and a 15-cm liver span. A guaiac test of his stool was negative. Laboratory findings included the following pertinent values: white blood cell count, 3,800/mm 3 ; hemoglobin, 8.3 g/dL; albumin, 2.6 g/dl.; total protein, 7.7 g/dl.; total bilirubin, 0.3 mg/dl.; alkaline phosphatase, 328 U/L; aspartate aminotransferase, 131 U/L; alanine aminotransferase, 178 U/L; and glutamyl transpeptidase, 113 U /L. Results ofstool cultures and ofevaluations for ova and parasites and Clostridium difficile toxin were negative. Therapy with zidovudine was restarted. Therapy with ketoconazole was begun for treating the patient's thrush and possible esophagitis. The patient underwent a barium enema that revealed multiple nodular and polypoid masses involving the sigmoid, descending, and transverse colon (figure I) as well as the ascending colon and cecum. No reflux into the terminal ileum was demonstrated, and the patient refused any further maneuvers. The colon otherwise was noted to have normal caliber and haustral markings. A colonoscopy was then performed. Multiple ulcers of varying size with heaped up edges and necrotic bases were seen throughout the colon; multiple biopsy specimens were taken. Clinical and histopathologic findings were considered to be consistent with colitis due to cytomegalovirus (CMV), and the patient began receiving iv ganciclovir.
