Mediastinal Infection With Candida glabrata in an Immunocompetent Patient

Abstract

INTRODUCTION: Aerodigestive fungal infections are commonly overlooked as they are often ascribed as colonization. In our review of the literature, active fungal infections with Candida, specifically Candida glabrata, were linked to immunocompromised patients with chronic mediastinal infection with Candida glabrata being rare (1,2). We report a unique case of chronic aerodigestive infection with subsequent mass formation and esophageal constriction secondary to Candida glabrata in an immunocompetent patient. CASE PRESENTATION: The patient is a 47-year-old male, who presented with nausea and vomiting for 3 months. Upon further workup with imaging studies (computed tomography (CT) abdomen/pelvis) to rule out anatomical obstruction, the patient was found to have a mediastinal mass, involving the esophagus; an EGD showed anatomical obstruction of the distal part of the esophagus (Image 2). Esophageal biopsies were performed, and an esophageal stent was placed. The patient initially underwent an autofluorescence bronchoscopy and bronchoalveolar lavage to assess for airway invasion. There was no direct invasion seen, but there was extrinsic compression of the trachea (Image 1). The respiratory culture from the bronchoalveolar lavage was positive for Candida species, not albicans. The esophageal biopsy was non-diagnostic, so the primary team consulted interventional pulmonology for an endobronchial ultrasound guided transbronchial needle aspiration and biopsy. The pathology from the biopsies was positive for Candida glabrata, sensitive to fluconazole. The patient was started on the appropriate treatment. DISCUSSION: Per our literature review this case is the first report of chronic mediastinal infection, causing mass effect secondary to Candida glabrata in an immunocompetent patient. The presenter will discuss salient features and management related to this rare presentation. CONCLUSIONS: The general workup of a mediastinal mass should include fungal organisms, including Candida glabrata.