A wasting syndrome and malnutrition caused by small intestine fungal overgrowth: Case report and review of the literature

Only a handful of case reports in the literature describe presence of Candida albicans in the gut of otherwise healthy subjects who were older adults and presented with gastrointestinal (GI) symptoms. In this article, the authors describe an interesting case report of a 48-y-old female with Sjogren's syndrome and stage II cervical cancer complicated by a rectovaginal fistulae postradiation therapy requiring a colectomy and ileostomy, who presented with a wasting syndrome consisting of unresolving watery diarrhea and a 40-pound (18.14 kg) weight loss in the course of 5 mo. On physical exam, she appeared to be a thin, fragile female with wasting in the subscapular and sternocleidomastoid area with benign GI exam. An upper endoscopy was unremarkable for any significant pathological entity. A small bowel fluid aspirate was positive for overgrowth of Candida tropicalis and also was found to have anti-Candida immunoglobulin A. The patient was begun on central parenteral nutrition and she completed a 3-wk course of fluconazole. She was gradually weaned off total parenteral nutrition during the next 3 mo, with slow reintroduction of healthy whole foods and had appropriate weight gain and resolution of her GI symptoms. This case shows how important dietary interventions can be in managing malnutrition. Adding proper nutrients and slowly eradicating the dysbiotic fungi in the small intestine can help in resolution of GI symptoms and return to functional status.