Necrotizing candida infection after percutaneous endoscopic gastrostomy: A fatal and rare complication

Gastrostomy site infections following percutaneous endoscopic gastrostomy (PEG) are the most common complication after PEG Placement. Recent meta-analyses were able to show that PEG site infections can he reduced significantly with a systemic anti microbial prophylaxis. This mostly cephalosporin- or penicillin-based prophylaxis does not cover fungal infections. Although Candida skin infections after PEG placement are rarely described, a mucosal colonization or infection of the upper Gl tract with Candida species is very common, especially in severely ill patients such its those requiring artificial nutrition. The authors report a rare and lethal case of a necrotizing PEG site infection with Candida albicans in a patient with diabetes with multiple comorbidities, presenting like gas gangrene. In patients with probable immunodeficiency or visible candidiasis of the skin, oropharynx, or esophagus, a Candida infection should be considered in case of a gastrostomy site infection.