Case-Report | DOI: https://doi.org/10.31579/2692-9392/011
1Department of Internal Medicine, Houston Methodist Hospital, Houston, Texas.
2Division of Gastroenterology, Department of Medicine, Houston Methodist Hospital, Houston, Texas.
3Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas.
4Sherrie and Alan Conover Center for Liver Disease, Houston Methodist Hospital, Houston, Texas
*Corresponding Author: Sudha Kodali, Sherrie and Alan Conover Center for Liver Disease, Houston Methodist Hospital, Houston, Texas.
Citation: Abughazaleh S., Daniel S. Zhang., Massey D., Mary R. Schwartz., David W. Victor., Kodali S., (2020) Fungki Ulcers. J. Archives of Medical Case Reports and Case Study. 3(1); DOI:10.31579/2692-9392/011
Copyright: © 2020 Sudha Kodali, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 01 June 2020 | Accepted: 29 January 2020 | Published: 06 July 2020
Keywords: crystals; liver disease
A 35-year-old female with end-stage renal disease on peritoneal dialysis presented with altered mental status and abdominal discomfort. On admission, she was found to have a distended tympanic abdomen and elevated WBC
35-year-old female with end-stage renal disease on peritoneal dialysis presented with altered mental status and abdominal discomfort. On admission, she was found to have a distended tympanic abdomen and elevated WBC. After a CT of abdomen and pelvis demonstrated free air, the patient was taken emergently to the OR for diagnostic laparoscopy which revealed bilious peritonitis and a 5 mm perforation in the distal ileum. She underwent a right hemicolectomy with ileocolonic anastomosis. The resected bowel had multifocal ulceration (Figure 1). Microscopic examination demonstrated diffuse acute serositis associated with fungal organisms compatible with Candida species (Figure 2). There were focal two-toned crystals with fish scale pattern having characteristic features of sevelamer crystals (Figure 3, 4). The patient had previously received sevelamer for treatment of hyperphosphatemia related to end-stage renal disease. The potential etiologic role of sevelamer in the development of bowel ischemia, ulceration and perforation is not clear. The patient was treated with anti-fungal medications and had subsequent resolution of peritonitis.
Author contributions: S. Abughazaleh, D. Zhang, M. Schwartz, and S. Kodali wrote the manuscript.
S. Kodali is the article guarantor. No financial support/competing interests. No conflict of interest. No previous presentations. Informed consent was obtained for this case report.
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