An 81-year-old male with diarrhea and increased carcinoembryonic antigen (CEA) was referred to our hospital. Past medical history included diabetes, pulmonary emphysema, and hypertension. Esophagogastroduodenoscopy (EGD) revealed ulcerous lesions with thick exudates on the anterior wall of the fornix. Pathological examination of biopsy specimens revealed exudative necrotic material and Candida. Upon confirming ulcer healing after oral administration of esomeprazole (20 mg/day) for 2 months, he was found to be positive for serum anti-Helicobacter pylori antibody and first-line therapy for H. pylori eradication started. The urea breath test showed that he became negative; however, EGD revealed recurrent ulcer six months later. Candida-associated gastric ulcer was suspected, and fluconazole was administered. Consequently, his ulcer improved, Candida disappeared in biopsy specimens and his CEA level decreased. So far, no finding suggesting recurrence has been observed.
In elderly patients with compromised immunity, Candida-associated gastric ulcer should be considered in the differential diagnoses of gastric ulcer.
