Two Cases of Fungemia after Endoscopic Variceal Obturation for Gastric Variceal Bleeding

다국어 초록 (Multilingual Abstract)

Fever is a common complication of endoscopic variceal obturation (EVO) therapy for gastric variceal bleeding. However, fungemiarelated to EVO therapy has not yet been reported. Herein, we report two cases of post-EVO fungemia in cirrhotic patientswho underwent therapeutic EVO for gastric variceal bleeding. Both patients developed sustained high fever after repeated EVOprocedures while on prophylactic antibiotic use. In both patients, blood cultures revealed yeast, and they were finally diagnosedwith Candida infection. Candida is a common member of the intestinal flora; however, it can cause invasive infection with consequentpoor prognosis in cirrhotic patients. The route of Candida invasion is unclear; however, repeated EVO may predisposepatients to Candida infection, particularly those who are in the end stage of liver disease and receiving prophylactic antibiotics.
Our cases highlight that repeated invasive procedures can increase the risk of fungal infections, and fungemia should be consideredin the differential diagnosis of post-EVO fever.

참고문헌 (Reference)

1 장재영, "식도 및 위정맥류의 예방과 치료" 대한내과학회 75 (75): 6-14, 2008

2 Cheng LF, "Treatment of gastric varices by endoscopic sclerotherapy using butyl cyanoacrylate: 10 years' experience of 635 cases" 120 : 2081-2085, 2007

3 Wahl P, "Septic complications after injection of N-butyl-2-cyanoacrylate : report of two cases and review" 59 : 911-916, 2004

4 Rerknimitr R, "Risk of bacteremia in bleeding and nonbleeding gastric varices after endoscopic injection of cyanoacrylate" 40 : 644-649, 2008

5 Reuken PA, "Recurrent fever and bacteraemia after endoscopic variceal haemostasis with cyanoacrylate : a case report" 40 : 351-353, 2012

6 Lee HA, "Prognosis of patients with gastric variceal bleeding after endoscopic variceal obturation according to the type of varices" 31 : 211-217, 2019

7 Bajaj JS, "Prediction of fungal infection development and their impact on survival using the NACSELD cohort" 113 : 556-563, 2018

8 Hwang SS, "N-butyl-2-cyanoacrylate pulmonary embolism after endoscopic injection sclerotherapy for gastric variceal bleeding" 25 : 16-22, 2001

9 Soehendra N, "N-butyl-2-cyanoacrylate : a supplement to endoscopic sclerotherapy" 19 : 221-224, 1987

10 Chang YJ, "Longterm outcomes of prophylactic endoscopic histoacryl injection for gastric varices with a high risk of bleeding" 55 : 2391-2397, 2010

11 Lahmer T, "Fungal"colonisation"is associated with increased mortality in medical intensive care unit patients with liver cirrhosis" 179 : 63-71, 2015

12 Hassan EA, "Fungal infection in patients with end-stage liver disease : low frequency or low index of suspicion" 23 : 69-74, 2014

13 Bajaj JS, "Fungal dysbiosis in cirrhosis" 67 : 1146-1154, 2018

14 Han Ah Lee, "Evaluation of Treatment Response after Endoscopic Variceal Obturation with Abdominal Computed Tomography" 거트앤리버 소화기연관학회협의회 14 (14): 117-124, 2020

15 Lee YT, "EUSguided injection of cyanoacrylate for bleeding gastric varices" 52 : 168-174, 2000

16 Yan L, "Disruption of the intestinal mucosal barrier in Candida albicans infections" 168 : 389-395, 2013

17 Seewald S, "Cyanoacrylate glue in gastric variceal bleeding" 34 : 926-932, 2002

18 Albillos A, "Cirrhosis-associated immune dysfunction : distinctive features and clinical relevance" 61 : 1385-1396, 2014

19 Fernández J, "Bacterial and fungal infections in acute-on-chronic liver failure : prevalence, characteristics and impact on prognosis" 67 : 1870-1880, 2018

20 Ho H, "A prospective controlled study of the risk of bacteremia in emergency sclerotherapy of esophageal varices" 101 : 1642-1648, 1991