Invasive gastric candidiasis presenting as gastric perforation in an immunocompetent adult: a rare case report.

Introduction: Gastric perforation is most commonly caused by peptic ulcer disease, malignancy, or trauma. Isolated gastric candidiasis leading to perforation is an exceptionally rare event, almost exclusively reported in severely immunocompromised hosts. We present a case of peritonitis secondary to Case presentation: A 25-year-old previously healthy man presented with a 2-day history of acute-onset, severe epigastric pain, and signs of peritonitis. He reported no history of antibiotic exposure, smoking, alcohol, nonsteroidal anti-inflammatory drug (NSAID) use, peptic ulcer disease/proton pump inhibitor use, or any immunocompromising conditions. Laboratory findings revealed leukocytosis. An upright abdominal X-ray demonstrated free subdiaphragmatic air, consistent with a hollow viscus perforation. An urgent exploratory laparotomy revealed a 1.5 cm perforated ulcer on the pre-pyloric region. A modified Graham patch repair was performed. Intraoperatively, a full-thickness biopsy of the ulcer margin was taken for histopathological examination. The pathology report revealed necrotic tissue with invasive fungal hyphae morphologically consistent with Discussion: Primary invasive gastric candidiasis resulting in perforation is exceptionally rare in immunocompetent hosts, with only sporadic cases reported in the literature. Although Conclusion: This case highlights that invasive gastric candidiasis can be a primary cause of life-threatening complications like perforation and peritonitis in immunocompetent individuals. It should be considered in the differential diagnosis of spontaneous gastric perforation, even in the absence of classic risk factors. Histopathological evaluation of perforation margins is crucial for diagnosis and guiding appropriate antifungal therapy.