Gastric Perforation Due to Fungal Infection in a Diabetic Patient: A Case Report and Review of the Literature.

Gastric perforation is a life-threatening surgical emergency most commonly caused by peptic ulcer disease. Fungal involvement, particularly by Candida albicans, is exceedingly rare but associated with poorer outcomes than bacterial peritonitis. We report a case of a 52-year-old man with type 2 diabetes mellitus who presented with acute abdominal pain and hemodynamic instability. Emergency laparotomy revealed a 5 mm perforation on the anterior gastric wall, which was repaired primarily. Postoperatively, the patient developed persistent sepsis, acute kidney injury, and hypoalbuminemia. Two weeks later, imaging showed focal dehiscence at the repair site. Intra-abdominal cultures grew Candida albicans and Pseudomonas aeruginosa, while blood cultures confirmed candidemia. Periodic acid-Schiff (PAS) staining demonstrated fungus-hyphae consistent with invasive gastric candidiasis. Despite antifungal therapy, the patient's condition deteriorated, necessitating re-exploration, where a friable gastric wall precluded re-repair. Candida albicans-associated gastric perforation is exceptionally uncommon, with less than 15 cases reported in the literature. Diabetes, malnutrition, and prolonged antibiotic exposure are key risk factors. Early recognition of fungal involvement, timely antifungal therapy, and tailored surgical management are critical to improving outcomes. This case highlights the importance of considering fungal etiologies in refractory intra-abdominal sepsis.