PMC6727104_01
The clinical course course up to the gastric perforation. CPZ/SBT: cefoperazone/sulbactam, VRCZ: voriconazole, L-AmB: Liposomal Amphotericin B, PSL: prednisolone.
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His clinical course up to gastric perforation is shown in Fig. 1.
The macroscopic appearance of transmural gastric necrosis and perforation of the lesser curvature of the stomach.
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Methylprednisolone was discontinued and an emergency laparotomy was performed that revealed turbid bilious fluid and perforation of the lesser curvature of the stomach with black large ulcer (8.5 cm x 5.5 cm) (Fig. 2).
The histological appearance in the ulcer part showing (a) necrosis with acute inflammation (H-E stain, x10), (b) a large number of budding yeasts (H-E stain, x40) and (c) some of yeasts inside blood vessels (H-E stain, x100). H-E: hematoxylin and eosin.
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Pathological examination revealed necrotic tissues associated with inflammation, a large number of budding yeasts, and some of them inside blood vessels (Fig. 3).
The histochemical stain. (a) Periodic acid-Schiff stain, (b) Grocott stain and (c) immunohistochemical stain for Candida (x100).
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These were immunohistochemically positive for Candida (Fig. 4) (negative for Aspergillus: data not shown, for mucormycosis: not tested).