title: Epigastric Distress Caused by Esophageal Candidiasis in 2 Patients Who Received Sorafenib Plus Radiotherapy for Hepatocellular Carcinoma: Case Report.
abstract: Sorafenib followed by fractionated radiotherapy (RT) has been shown to decrease the phagocytic and candidacidal activities of antifungal agents due to radiosensitization. Moreover, sorafenib has been shown to suppress the immune system, thereby increasing the risk for candida colonization and infection. In this study, we present the 2 hepatocellular carcinoma (HCC) patients suffered from epigastric distress caused by esophageal candidiasis who received sorafenib plus RT. Two patients who had received sorafenib and RT for HCC with bone metastasis presented with hiccups, gastric ulcer, epigastric distress, anorexia, heart burn, and fatigue. Empiric antiemetic agents, antacids, and pain killers were ineffective at relieving symptoms. Panendoscopy revealed diffuse white lesions in the esophagus. Candida esophagitis was suspected. Results of periodic acid-Schiff staining were diagnostic of candidiasis. Oral fluconazole (150 mg) twice daily and proton-pump inhibitors were prescribed. At 2-weak follow-up, esophagitis had resolved and both patients were free of gastrointestinal symptoms. Physicians should be aware that sorafenib combined with RT may induce an immunosuppressive state in patients with HCC, thereby increasing their risk of developing esophagitis due to candida species.
authors.affiliation: From the Department of Surgery (K-HC), Department of Internal Medicine (M-TW), Department of Anatomical Pathology (Y-HC), Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, New Taipei City (Y-FL, C-HH), Department of Electrical Engineering (K-HC), Department of Chemical Engineering & Materials Science, Yuan-Ze University, Taoyuan (M-TW), Department of Medicine (C-HH), and Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan (C-HH).
authors.forename: Kuo-Hsin
authors.initials: KH
authors.lastname: Chen
authors.forename: Meng-Tzu
authors.initials: MT
authors.lastname: Weng
authors.forename: Yueh-Hung
authors.initials: YH
authors.lastname: Chou
authors.forename: Yueh-Feng
authors.initials: YF
authors.lastname: Lu
authors.forename: Chen-Hsi
authors.initials: CH
authors.lastname: Hsieh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002177:Candidiasis / Q000139:chemically induced / Q000150:complications*; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy* / Q000532:radiotherapy; D019583:Dose Fractionation, Radiation; D004941:Esophagitis / Q000188:drug therapy / Q000382:microbiology*; D015725:Fluconazole / Q000627:therapeutic use; D006356:Heartburn / Q000382:microbiology; D006606:Hiccup / Q000382:microbiology; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy; D008297:Male; D009536:Niacinamide / Q000009:adverse effects / Q000031:analogs & derivatives*; D010671:Phenylurea Compounds / Q000009:adverse effects*; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D000077157:Sorafenib; D013276:Stomach Ulcer / Q000382:microbiology
chemical_list: D000935:Antifungal Agents; D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D054328:Proton Pump Inhibitors; D009536:Niacinamide; D015725:Fluconazole; D000077157:Sorafenib