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Keywords

Clinical Practice in Athletic Training

Abstract

Background: Candidiasis is a yeast-based fungal infection often found in immunocompromised individuals, that can produce white patches, redness or soreness in the mouth, xerostomia, loss of taste, pain with eating and swallowing, and angular cheilitis. The patient in this case is a 21-yearold male baseball player who presented to the athletic trainer (AT) with flu-like symptoms such as fever, cough, body aches, shortness of breath, and chills. The AT referred the patient to the team physician, who prescribed Zithromax five days after the onset of symptoms for bronchitis. There was no improvement after two days, so a Medrol pack was prescribed to alleviate shortness of breath. Three days later, the patient went to the emergency department (ED) complaining of vomiting after the consumption of food for the last 24 hours and hemoptysis. A computed tomography (CT) angiogram of the patient’s chest was ordered but imagining was unremarkable. He was discharged the same day with a prescription for acetaminophen, codeine-guaifenesin, and ondansetron. Two days later, he reported to the team physician with complaints of stomach pain, dark urine, dark stools, coughing, and vomiting. He was prescribed Zofran with Codeine syrup to alleviate vomiting. The next day, he returned to the ED complaining of vomiting after the consumption of fluids, stomach pain, and dark stool. The physician ordered a non-contrast CT scan of the patient’s abdomen and pelvis, which was unremarkable. He was discharged the same day with a prescription for famotidine, promethazine, and sucralfate. Three days later he was referred to a gastroenterologist (GI). The GI admitted the patient into the hospital to undergo an esophagogastroduodenoscopy (EGD) due to the loss of 20 pounds in two weeks. Differential Diagnosis: Initial suspicions included upper respiratory infection, bronchitis, or peptic ulcer. Treatment: The EGD discovered that the patient had a diaphragmatic hernia and a candidiasis fungal infection inside of the esophagus. The patient was prescribed an anti-fungal medication and discharged after three days. Within a few days, the patient was able to tolerate eating and drinking. Caution had to be taken when introducing foods back into his diet, as he was at risk for developing refeeding syndrome, a potentially fatal shift in the fluids and electrolytes that occurs in malnourished patients receiving artificial refeeding. The patient consulted with a registered dietician (RD) who prescribed a multivitamin, 100mg of thiamine, and recommended a high carbohydrate and protein diet. Two weeks after the patient was discharged, he was cleared by the AT and RD to begin the return-to-play (RTP) protocol. The RTP protocol introduced activities such as riding a stationary bike and weightlifting workouts. Once light activities were tolerable, he started incorporating baseball-specific activities such as hitting, tossing, and base-running. The patient made a full recovery and returned to sport 3 months after the EGD procedure. Uniqueness: Candidiasis in the esophagus is typically seen in individuals with a weakened immune system, such as those living with human immunodeficiency virus/acquired immunodeficiency syndrome and those who have cancers such as leukemia and lymphoma. Since esophageal candidiasis is unique in a healthy population, there is not a protocol to follow when returning to activity. In this case, the AT treated the patient’s RTP similarly to the COVID-19 RTP protocol, which focuses on light activity and slowly progresses as the patient can tolerate. Conclusion: The case outlines a 21-year-old baseball player who suffered from an esophageal candidiasis infection. Understanding the symptoms of candidiasis as well as how to avoid refeeding syndrome was imperative to treating this patient. The patient in this case was able to make a full recovery and returned to baseball as normal.

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