DOI QR코드

DOI QR Code

Recurrent Esophageal Stricture Caused by Candidiasis in an HIV-Infected Patient

HIV 감염 환자에서 칸디다증에 의하여 발생한 반복적인 식도 협착증

  • Shin, Hye-Sun (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Bae, Yoon-Sung (Department of Pathology, Yonsei University College of Medicine) ;
  • Han, Sang-Hoon (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Choi, Jun-Yong (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Shin, Sung-Kwan (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Song, Young-Goo (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Kim, June-Myung (Department of Internal Medicine, Yonsei University College of Medicine)
  • 신혜선 (연세대학교 의과대학 내과학교실) ;
  • 배윤성 (연세대학교 의과대학 병리학교실) ;
  • 한상훈 (연세대학교 의과대학 내과학교실) ;
  • 최준용 (연세대학교 의과대학 내과학교실) ;
  • 신성관 (연세대학교 의과대학 내과학교실) ;
  • 송영구 (연세대학교 의과대학 내과학교실) ;
  • 김준명 (연세대학교 의과대학 내과학교실)
  • Published : 2012.02.01

Abstract

Esophageal candidiasis is a common opportunistic infection that develops in human immunodeficiency virus (HIV)-infected patients. It is usually effectively treated with fluconazole, and the occurrence of an esophageal stricture in association with esophageal candidiasis has rarely been reported in HIV-infected patients. In the case presented here, a 49-year-old man was diagnosed with severe esophageal candidiasis with HIV infection. At the time of the HIV diagnosis, he had immunodeficient status with a CD4+ T lymphocyte count of 150 cells/$mm^{3}$. He received antifungal treatment with fluconazole and combined antiretroviral therapy. Although the esophageal candidiasis improved with rapid recovery of the CD4+ T lymphocyte count, a recurrent esophageal stricture developed. To treat the recurrent esophageal stricture, the patient received repeated balloon dilatation and stent insertion. We report this rare case of severe esophageal stricture complication of esophageal candidiasis in an HIV-infected patient.

식도 칸디다증은 면역결핍상태의 HIV 감염 환자에서 흔하게 관찰될 수 있는 기회감염 중 하나이다. HIV 감염 환자에서 식도 칸디다증의 합병증으로 식도협착증이 발생하는 것은 매우 드문 것으로 알려져 있으며, HIV 감염 환자에서 칸디다 감염으로 인하여 면역재구성염증증후군이 발생하였다는 보고도 없다. 저자들은 면역결핍상태의 HIV 감염 환자에서 심한 식도 칸디다증으로 fluconazole 항진균제 치료와 고강도 항레트로바이러스 치료를 시행한 후 식도 칸디다증은 호전되었지만 반복적인 식도협착증이 발생한 1예를 경험하였기에 보고하는 바이다.

Keywords

References

  1. Wilcox CM. Esophageal disease in the acquired immunodeficiency syndrome: etiology, diagnosis, and management. Am J Med 1992;92:412-421. https://doi.org/10.1016/0002-9343(92)90272-D
  2. Lee SH. Treatment and prevention of opportunistic infections in HIV-infected patients. J Korean Med Assoc 2007;50:324-329. https://doi.org/10.5124/jkma.2007.50.4.324
  3. Zaidi SA, Cervia JS. Diagnosis and management of infectious esophagitis associated with human immunodeficiency virus infection. J Int Assoc Physicians AIDS Care (Chic) 2002;1:53-62. https://doi.org/10.1177/154510970200100204
  4. Kim BW, Cho SH, Rha SE, et al. Esophagomediastinal fistula and esophageal stricture as a complication of esophageal candidiasis: a case report. Gastrointest Endosc 2000;52:772-775. https://doi.org/10.1067/mge.2000.108922
  5. Kim JM, Cho GJ, Hong SK, et al. Epidemiology and clinical features of HIV infection/AIDS in Korea. Yonsei Med J 2003;44:363-370. https://doi.org/10.3349/ymj.2003.44.3.363
  6. Cole GT, Halawa AA, Anaissie EJ. The role of the gastrointestinal tract in hematogenous candidiasis: from the laboratory to the bedside. Clin Infect Dis 1996;22(Suppl 2):S73-S88. https://doi.org/10.1093/clinids/22.Supplement_2.S73
  7. Grant PM, Komarow L, Andersen J, et al. Risk factor analyses for immune reconstitution inflammatory syndrome in a randomized study of early vs. deferred ART during an opportunistic infection. PLoS One 2010;5:e11416. https://doi.org/10.1371/journal.pone.0011416
  8. Shelburne SA, Visnegarwala F, Darcourt J, et al. Incidence and risk factors for immune reconstitution inflammatory syndrome during highly active antiretroviral therapy. AIDS 2005;19:399-406. https://doi.org/10.1097/01.aids.0000161769.06158.8a