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