Abstract
A 58-year-old man, with past histories of tuberculosis and diabetes, underwent total gastrectomy with Rouxen-Y reconstruction because of a stage I gastric cancer located at the posterior wall of upper one-third of the stomach. After the operation, malnutritional status of unknown cause and uncontrollable ascites were prolonged in spite of favorable appetite. Although fever, leukocytosis and elevated level in C-reactive protein continued after 18th postoperative day, no pathogenic bacteria were identified in the ascites, blood, urine and sputum. Left pleural effusion developed on 33rd postoperative day, followed by sudden respiratory distress and shock on 33th day, resulting in death on 40th day. Autopsy revealed chronic and acute panperitonitis with a lot of purulent ascites, and histopathological examination revealed disseminated candidiasis with pneumonia, acute pyelonephritis, and microabscess of the liver, pararenal gland and myocardium. It is considered that rapid serological diagnostic methods should be performed under a strong suspicion of fungal infection in cases that inflammatory signs of unknown origin are prolonged after total gastrectomy.
