Invasive candidiasis complicating spontaneous esophageal perforation (Boerhaave syndrome)
Bauer, T.M.; Dupont, V.; Zimmerli, W.
American Journal of Gastroenterology 91(6): 1248-1250
1996
ISSN/ISBN: 0002-9270 PMID: 8651181 Document Number: 464570
Spontaneous esophageal perforation is a rare condition that frequently results. in infectious complications. Empirical broad-spectrum antibacterial therapy is therefore part of the standard management. We describe two patients suffering from spontaneous esophageal perforation who developed invasive candidiasis with hematogenous dissemination. One patient died of multiple organ failure due to Candida sepsis. Preexistent Candida colonization, incomplete mediastinal drainage, broadspectrum antibacterial therapy, and prolonged intensive care therapy place patients with esophageal perforation at high risk for secondary fungal infection. Intense microbiological searching is mandatory, but the distinction between colonization and infection may be impossible. Empirical antifungal treatment with imidazole derivatives, particularly in patients with potential risk factors, should be considered.