Clinical and Experimental Medicine

, Volume 12, Issue 3, pp 201–205 | Cite as

Malignant tumor-like gastric lesion due to candida albicans in a diabetic patient treated with cyclosporin: a case report and review of the literature

  • Pasquale MansuetoEmail author
  • Giuseppe Pisciotta
  • Giovanni Tomasello
  • Daniela Cabibi
  • Aurelio Seidita
  • Alberto D’Alcamo
  • Angelo Maria Patti
  • Delia Sprini
  • Antonio Carroccio
  • Giovam Battista Rini
  • Gaetana Di Fede
Case Report


The gastrointestinal tract of healthy individuals is colonized by hundreds of saprophytes and mycetes, especially the Candida species, are habitual ones. Under certain conditions, the fungal flora may overgrow, resulting in lesions of the digestive mucosa which, rarely, can have a local diffusion and/or spread to the lympho-hematogenous system. Mycotic infections of the stomach can sometimes look like benign gastric ulcers. Here, we present the case report of a woman, aged 64, who presented with type II diabetes mellitus and psoriasis, on chronic treatment with cyclosporin A and with endoscopic evidence of an ulcerated, vegetating gastric lesion secondary to Candida albicans infection. Although strongly suggestive of malignancy, it completely healed after cyclosporin withdrawal and the administration of oral antifungal drugs.


Candidiasis Mycotic infection of the gastrointestinal tract Submucosal tumor 


Conflict of interest



  1. 1.
    Gottlieb K, Mobarhan S (1994) Review: microbiology of the gastrostomy tube. J Am Coll Nutr 13:311–313PubMedGoogle Scholar
  2. 2.
    Bernhardt H, Knoke M (1997) Mycological aspects of gastrointestinal microflora. Scand J Gastroenterol 222:102–106Google Scholar
  3. 3.
    Katzenstein AL, Maksem J (1979) Candidal infection of gastric ulcers. Histology, incidence and clinical significance. Am J Clin Pathol 71:137–141PubMedGoogle Scholar
  4. 4.
    Ramaswamy K, Correa M, Koshy A (2007) Non-healing gastric ulcer associated with Candida infection. Indian J Med Microbiol 25:57–58PubMedCrossRefGoogle Scholar
  5. 5.
    Karczewska E, Wojtas I, Sito E, Trojanowska D, Budak A, Zwolinska-Wcislo M, Wilk A (2009) Assessment of co-existence of Helicobacter pylori and Candida fungi in diseases of the upper gastrointestinal tract. J Physiol Pharmacol 60(Suppl 6):33–39PubMedGoogle Scholar
  6. 6.
    Nishimura S, Nagata N, Kobayakawa M, Sako A, Nakashima R, Uemura N (2011) A case of candidal infection of gastric ulcers with characteristic endoscopic findings. Nihon Shokakibyo Gakkai Zasshi 108:1393–1398PubMedGoogle Scholar
  7. 7.
    Eras P, Goldstein MJ, Sherlock P (1972) Candida infection of the gastrointestinal tract. Medicine 51:367–379PubMedCrossRefGoogle Scholar
  8. 8.
    Cohen R, Roth FJ, Delgado E, Ahearn DG, Kalser MH (1969) Fungal flora of the normal human small and large intestine. N Engl J Med 280:638–641PubMedCrossRefGoogle Scholar
  9. 9.
    Bernhardt J (1999) Orointestinal candidiasis with special emphasis on esophageal candidiasis. Mycoses 42:68–72PubMedCrossRefGoogle Scholar
  10. 10.
    Zwolinska-Wcisło M, Budak A, Bogdał J, Trojanowska D, Stachura J (2001) Fungal colonization of gastric mucosa and its clinical relevance. Med Sci Monit 7:982–988PubMedGoogle Scholar
  11. 11.
    Kodsi BE, Wickremesinghe C, Kozinn PJ, Iswara K, Goldberg PK (1976) Candida esophagitis: a prospective study of 27 cases. Gastroenterology 71:715–719PubMedGoogle Scholar
  12. 12.
    Vilotte J, Toutoungi M, Coquillard A (1981) Candida infection of gastric ulcers. 6 cases (author’s transl). Nouv Presse Med 10:1471–1474PubMedGoogle Scholar
  13. 13.
    Huppmann AR, Orenstein JM (2010) Opportunistic disorders of the gastrointestinal tract in the age of highly active antiretroviral therapy. Hum Pathol 41:1777–1787PubMedCrossRefGoogle Scholar
  14. 14.
    Nicholls PE, Henry K (1978) Gastritis and cimetidine: a possible explanation. Lancet 1:1095–1096PubMedCrossRefGoogle Scholar
  15. 15.
    Cat TB, Charash W, Hebert J, Marden BT, Corbett SM, Ahern J, Rebuck JA (2009) Potential influence of antisecretory therapy on the development of Candida-associated intraabdominal infection. Ann Pharmacother 42:185–191Google Scholar
  16. 16.
    Morishita T, Kamiya T, Munakata Y, Tsuchiya M (1993) Radiologic and endoscopic studies of gastric ulcers associated with Candida infection. Acta Gastroenterol Latinoam 23:223–229PubMedGoogle Scholar
  17. 17.
    Knoke M, Bernhardt H (1980) Endoscopic aspects of mycosis in the upper digestive tract. Endoscopy 12:295–298PubMedCrossRefGoogle Scholar
  18. 18.
    Korać M, Brmbolić B, Salemović D, Ranin J, Stojsić Z, Jevtović D, Nikolić J (2009) Diagnostic esophago-gastro-duodenoscopy (EGD) in patients with AIDS-related upper gastrointestinal abnormalities. Hepatogastroenterology 56:1675–1678PubMedGoogle Scholar
  19. 19.
    Peters M, Weiner J, Whelan G (1980) Fungal infection associated with gastroduodenal ulceration: endoscopic and pathologic appearances. Gastroenterology 78:350–354PubMedGoogle Scholar
  20. 20.
    Reddy BS, Gatt M, Sowdi R, Mitchell CJ, MacFie J (2008) Gastric colonization predisposes to septic morbidity in surgical patients: a prospective study. Nutrition 24:632–637PubMedCrossRefGoogle Scholar
  21. 21.
    Bollo J, Carrilo E, Lupu I, Caballero F, Trias M (2009) Gastric perforation associated with Candida infection. Gastroenterol Hepatol 32:499–501PubMedCrossRefGoogle Scholar
  22. 22.
    Ishiguro T, Takayanagi N, Ikeya T, Yoshioka H, Yanagisawa T, Hoshi E, Hoshi T, Sugita Y, Kawabata Y (2010) Isolation of Candida species is an important clue for suspecting gastrointestinal tract perforation as a cause of empyema. Intern Med 49:1957–1964PubMedCrossRefGoogle Scholar
  23. 23.
    Di Febo G, Miglioli M, Calò G, Biasco G, Luzza F, Gizzi G, Cipollini F, Rossi A, Barbara L (1985) Candida albicans infection of gastric ulcer frequency and correlation with medical treatment. Results of a multicenter study. Dig Dis Sci 30:178–181PubMedCrossRefGoogle Scholar
  24. 24.
    Minoli G, Terruzzi V, Ferrara A, Casiraghi A, Rocca F, Rainer H, Porro A, Butti GC, Mandelli PG, Piffer R et al (1984) A prospective study of relationships between benign gastric ulcer, Candida, and medical treatment. Am J Gastroenterol 79:95–97PubMedGoogle Scholar
  25. 25.
    Saunus JM, Kazoullis A, Farah CS (2008) Cellular and molecular mechanisms of resistance to oral Candida albicans infections. Front Biosci 13:5345–5358PubMedCrossRefGoogle Scholar
  26. 26.
    Ashman RB, Farah CS, Wanasaengsakul S, Hu Y, Pang G, Clancy RL (2004) Innate versus adaptive immunity in Candida albicans infection. Immunol Cell Biol 82:196–204PubMedCrossRefGoogle Scholar
  27. 27.
    Conti HR, Shen F, Nayyar N, Stocum E, Sun JN, Lindemann MJ, Ho AW, Hai JH, Yu JJ, Jung JW, Filler SG, Masso-Welch P, Edgerton M, Gaffen SL (2009) Th17 cells and IL-17 receptor signaling are essential for mucosal host defense against oral candidiasis. J Exp Med 206:299–311PubMedCrossRefGoogle Scholar
  28. 28.
    Geerlings SE, Hoepelman AI (1999) Immune dysfunction in patients with diabetes mellitus (DM). FEMS Immunol Med Microbiol 26:259–265PubMedCrossRefGoogle Scholar
  29. 29.
    Soysa NS, Samaranayake LP, Ellepola AN (2006) Diabetes mellitus as a contributory factor in oral candidosis. Diabet Med 23:455–459PubMedCrossRefGoogle Scholar
  30. 30.
    Liu H, Wang Y, Li S (2007) Advanced delivery of ciclosporin A: present state and perspective. Expert Opin Drug Deliv 4:349–358PubMedCrossRefGoogle Scholar
  31. 31.
    Italia JL, Bhardwaj V, Kumar MN (2006) Disease, destination, dose and delivery aspects of ciclosporin: the state of the art. Drug Discov Today 11:846–854PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Pasquale Mansueto
    • 1
    Email author
  • Giuseppe Pisciotta
    • 1
  • Giovanni Tomasello
    • 2
  • Daniela Cabibi
    • 3
  • Aurelio Seidita
    • 1
  • Alberto D’Alcamo
    • 1
  • Angelo Maria Patti
    • 1
  • Delia Sprini
    • 1
  • Antonio Carroccio
    • 4
  • Giovam Battista Rini
    • 1
  • Gaetana Di Fede
    • 1
  1. 1.Internal Medicine, Department of Clinical Medicine and Emerging DiseasesUniversity Hospital of PalermoPalermoItaly
  2. 2.Surgery DepartmentUniversity Hospital of PalermoPalermoItaly
  3. 3.Pathology DepartmentUniversity Hospital of PalermoPalermoItaly
  4. 4.Internal Medicine, Ospedali Civili Riuniti di Sciacca (AG)University of PalermoPalermoItaly

Personalised recommendations