Challenges in the Management of Esophageal Variceal Rupture Coexisting with Esophageal Candidiasis: A Case Report
- Authors
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Nabila Rafif Nugroho, S.Ked
Fakultas Kedokteran dan Ilmu Kesehatan Universitas Muhammadiyah Yogyakarta
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dr. Warih Tjahjono, Sp.PD
Panembahan Senopati Bantul General Hospital
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- Abstract
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Background: Esophageal variceal rupture is a complication of portal hypertension associated with chronic liver disease, such as hepatitis B. Endoscopic variceal ligation (EVL) is one of the standard treatments for this condition. However, the coexistence of opportunistic infections, such as acute esophageal candidiasis, presents a distinct clinical challenge during invasive procedures. This case report aims to describe the emergency management of esophageal variceal rupture with coexisting esophageal candidiasis associated with active bleeding during the ligation procedure. Case Illustration: A 52-year-old man with hepatitis B-related liver cirrhosis was initially admitted in April 2026 with complaints of fever, diarrhea, and abdominal pain. Initial endoscopy results showed esophageal varices without any fungal infection. Two weeks later, in May 2026, the patient was readmitted due to massive melena resulting from a ruptured esophageal varices. When EVL was initiated the following day, esophageal candidiasis, which had not been previously detected, was identified. During the EVL procedure, a reduction in variceal size from grade F3 to F2 was observed, and complications arose in the form of active bleeding at the manipulated mucosal site, leading to postponement of the ligation procedure. Management focused on hemodynamic resuscitation, administration of tranexamic acid, blood transfusion, and supportive therapy. The patient was successfully stabilized and discharged on outpatient therapy. Discussion: Esophageal candidiasis causes inflammation and ulceration of the mucosa; when this coexists with ligation-induced ulcers resulting from EVL, it increases mucosal fragility. In the event of procedural failure and bleeding due to mucosal complications, postponing invasive procedures and shifting the focus to haemodynamic resuscitation and clinical stabilisation are the primary life-saving measures. Conclusion: This case highlights the rapid progression of opportunistic infections in immunocompromised cirrhosis patients, where the priority management is haemodynamic stability before replanning invasive procedures. This evaluation emphasises the importance of flexibility in clinical decision-making based on prioritisation to save patients’ lives in complex situations.
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Copyright (c) 2026 Nabila Rafif Nugroho, S.Ked, dr. Warih Tjahjono, Sp.PD
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