Fatal Candida esophagitis in two diabetics after renal transplantation
J. M. Jones, N. R. Glass and F. O. Belzer
Severe necrotizing Candida esophagitis developed in two insulin-dependent
diabetics after they received renal allografts. In each patient, the
infection led to a perforation of the esophagus and was ultimately fatal
despite aggressive medical and surgical management. The frequency and
severity of Candida esophagitis seems to be higher in diabetics rather than
in nondiabetic patients who received renal transplants. In these two
diabetic transplant recipients, small doses of oral nystatin did not
prevent Candida esophagitis. Appropriate diagnostic tests must be performed
promptly when symptoms of odynophagia or dysphagia develop in these
patients. In diabetic transplant recipients with documented candidiasis,
decreased symptoms of esophagitis should not be relied on to indicate a
response to therapy. Discontinuation of immunosuppressive drugs, as well as
aggressive treatment with oral and parenterally absorbed antifungal agents,
offer the best hope for preventing severe morbidity or mortality from the
infection in these patients.
