| 당뇨병성 케톤산증과 고삼투압성 고혈당상태의 병발로 진단된 당뇨병환자에서 발생한 위막성 구강인두캔디다증 1예 |
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송탁호, 정인국, 양주연, 서평주, 김동민, 강명수, 김도희, 정현경, 김희진 |
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| A Case of Oropharyngeal Pseudomembranous Candidiasis in a Patient with Diabetes Manifesting as Mixed Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State |
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Tak Ho Song, In Kook Jeong, Ju Yeon Yang, Pyeong Ju Seo, Dong Min Kim, Myeong Soo Kang, Do Hee Kim, Hyun Kyung Chung, Hee Jin Kim |
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| Abstract |
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Pseudomembranous candidiasis is a type of oropharyngeal candidiasis that is characterized by extensive white pseudomembranes consisting of desquamated epithelial cells, fibrin, and fungal hyphae. We report a case of oral pseudomembranous candidiasis accompanied by mixed diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) at the presentation of diabetes. A 24-year-old man, who presented with a blood glucose concentration of 98.3 mmol/L, pH of 7.289, an anion gap of 28.7 and serum creatinine of 283 μmol/L, was referred to our hospital. He had suffered from a sore throat for 3 days and had lost 7 kg of body weight over the previous month. Upon admission, an oral examination revealed multiple white patches on the surface of the labial and buccal mucosa, palate, tongue, periodontal tissues and oropharynx. The membrane could be scraped off with a swab to expose an underlying erythematous mucosa. The laboratory data showed a serum osmolality of 368 mOsm/kg, positive serum ketone (3+) and A1C of 14.8%. The anti-GAD antibodies were positive. The mixed DKA and HHS were treated with intravenous insulin, fluids and electrolytes. The oropharyngeal candidiasis was managed successfully with nystatin gargling and oral fluconazole. The ketoacidosis and azotemia were resolved after the appropriate management. |
| Key Words:
Diabetic ketoacidosis, Hyperosmolar hyperglycemic State, Oral candidiasis, Pseudomembranous candidiasis |
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