Candida albicans–associated necrotizing vasculitis producing life-threatening gastrointestinal hemorrhage

Sargent, Jeremy; O'Marcaigh, Aengus; Smith, Owen; Butler, Karina; Gavin, Patrick J.; O’Sullivan, Maureen

doi:10.1016/j.humpath.2009.09.015

Cited by 9 publications

(12 citation statements)

References 12 publications

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“…As Candida organisms invade blood vessels, they can cause mycotic aneurysms or thrombophlebitis. Necrotizing vasculitis has been described in candidemia, but organisms are not observed in the necrotic vessels, supporting the concept that Candida soluble fractions cause the necrotizing lesions (141). In patients with neutropenia the necrosis is usually accompanied by hemorrhage, and few lymphocytes and macrophages can be observed.…”

Section: Candidiasis (I) Epidemiologic and Clinical Situations When mentioning

confidence: 79%

Histopathologic Diagnosis of Fungal Infections in the 21st Century

2011

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SUMMARY Fungal infections are becoming more frequent because of expansion of at-risk populations and the use of treatment modalities that permit longer survival of these patients. Because histopathologic examination of tissues detects fungal invasion of tissues and vessels as well as the host reaction to the fungus, it is and will remain an important tool to define the diagnostic significance of positive culture isolates or results from PCR testing. However, there are very few instances where the morphological characteristics of fungi are specific. Therefore, histopathologic diagnosis should be primarily descriptive of the fungus and should include the presence or absence of tissue invasion and the host reaction to the infection. The pathology report should also include a comment stating the most frequent fungi associated with that morphology as well as other possible fungi and parasites that should be considered in the differential diagnosis. Alternate techniques have been used to determine the specific agent present in the histopathologic specimen, including immunohistochemistry, in situ hybridization, and PCR. In addition, techniques such as laser microdissection will be useful to detect the now more frequently recognized dual fungal infections and the local environment in which this phenomenon occurs.

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Section: Candidiasis (I) Epidemiologic and Clinical Situations When mentioning

confidence: 79%

Histopathologic Diagnosis of Fungal Infections in the 21st Century

2011

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“…Invasive and potentially fatal Candida infection of the small intestine has also been described in immunocompromised patients following allogeneic bone marrow transplantation [21 -23]. Interestingly, invasive Candida infection has also been linked with mesenteric vasculitis, resulting in severe ulcerative enteritis and intestinal hemorrhage [24]. However, alterations consistent with vasculitis could not be demonstrated histologically in our patient.…”

Section: Discussionmentioning

confidence: 61%

Fatal ulcerative enteritis of the small intestine in a patient with ulcerative colitis treated with vedolizumab

et al. 2017

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Vedolizumab (VDZ) inhibits α4β7 integrins and is used to target intestinal immune responses in patients with inflammatory bowel disease, which is considered to be relatively safe. Here we report on a fatal complication following VDZ administration. A 64-year-old female patient with ulcerative colitis (UC) refractory to tumor necrosis factor inhibitors was treated with VDZ. One week after the second VDZ infusion, she was admitted to hospital with severe diarrhea and systemic inflammatory response syndrome (SIRS). Blood stream infections were ruled out, and endoscopy revealed extensive ulcerations of the small intestine covered with pseudomembranes, reminiscent of invasive candidiasis or mesenteric ischemia. Histology confirmed subtotal destruction of small intestinal epithelia and colonization with Candida. Moreover, small mesenteric vessels were occluded by hyaline thrombi, likely as a result of SIRS, while perfusion of large mesenteric vessels was not compromised. Beta-D-glucan concentrations were highly elevated, and antimycotic therapy was initiated for suspected invasive candidiasis but did not result in any clinical benefit. Given the non-responsiveness to anti-infective therapies, an autoimmune phenomenon was suspected and immunosuppressive therapy was escalated. However, the patient eventually died from multi-organ failure. This case should raise the awareness for rare but severe complications related to immunosuppressive therapy, particularly in high risk patients.

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“…Candida is the most common fungi to cause this pathology, either by direct invasion of the vascular wall, as observed in this case, or mycotic emboli. 9 The long-term use of methotrexate in our patient was thought to contribute to his susceptibility for fungal infection, compounded by suboptimal oral hygiene in the peri-operative phase.…”

Section: Letters To the Editormentioning

confidence: 81%

“…However, an increase in serum rosuvastatin concentration due to genetic polymorphism in OATP1B1 and BCRP transporter proteins cannot be ruled out. 8 The Naranjo scale, 9 a validated tool for assessing the probability of adverse drug reaction, estimated the association of rosuvastatin with fever in this case as 'probable' rather than 'certain', with a score of 7. However, the Naranjo scale probably underestimated this association because of weightings for variables, such as previous reporting of similar events and serum drug concentrations, which are not applicable to rosuvastatin.…”

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confidence: 99%