연하곤란으로 내원한 칸디다 식도염... 기저질환 여부??

50대 중반 남자

1주일간의 연하곤란 (dysphagia)로 내원

기저 질환 (-)

흡연/음주

3년전 건진시행

위내시경; 심한 칸디다 식도염 양상, KOH (+)

왼쪽은 타인의 정상 식도/오른쪽은 환자 식도

Host defense mechanisms against Candida infection and their associated defects that allow infection are as follows:

1. Intact mucocutaneous barriers - Wounds, intravenous catheters, burns, ulcerations

2. Phagocytic cells - Granulocytopenia

3. Polymorphonuclear leukocytes - Chronic granulomatous disease

4. Monocytic cells - Myeloperoxidase deficiency

5. Complement - Hypocomplementemia

6. Immunoglobulins - Hypogammaglobulinemia

7. Cell-mediated immunity - Chronic mucocutaneous candidiasis, diabetes mellitus, cyclosporin A, corticosteroids, HIV infection

8. Mucocutaneous protective bacterial flora - Broad-spectrum antibiotics

Risk factors associated with invasive or systemic candidiasis include the following:

1. Granulocytopenia

2. Bone marrow transplantation

3. Solid organ transplantation (liver, kidney)

4. Parenteral hyperalimentation

5. Hematologic malignancies

6. Foley catheters

7. Solid neoplasms

8. Recent chemotherapy or radiation therapy

9. Corticosteroids

10. Broad-spectrum antibiotics

11. Burns

12. Prolonged hospitalization

13. Severe trauma

14. Recent bacterial infection

15. Recent surgery

16. Gastrointestinal tract surgery

17. Central intravascular access devices

18. Premature birth

19. Hemodialysis

20. Acute and chronic renal failure

21. Mechanical ventilation for longer than 3 days

건강검진 소변검사가 dipstick으로 금방 나오므로 확인결과 요당 +++

당뇨가 의심됨. 당화혈색소/hiv 항체/백혈구,혈소판 등 추가 검사 시행하였으며 혈액검사 결과 확인 필요.

항진균제 처방

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HbA1c; 12.1 로 상승되어 있어 당뇨 진단.

동대문구 답십리 우리안애, 우리안愛 내과, 건강검진 클리닉 내과 전문의 전병연