Oral Candidiasis Induced by Inhaled Corticosteroids in A COPD Patient with Diabetes: A Case Report

Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition often managed with a combination of bronchodilators and inhaled corticosteroids (ICS) to reduce inflammation and prevent exacerbations. While ICS therapy, particularly in the form of Budesonide/Formoterol combinations, offers considerable clinical benefit, it also carries a risk of localized adverse effects, such as oropharyngeal candidiasis. This case report presents a 65-year-old male patient with a history of COPD, hypertension, and type 2 diabetes mellitus who developed oral candidiasis following the use of an ICS-containing inhaler during hospitalization for an acute COPD exacerbation. The patient had been treated with intravenous antibiotics, corticosteroids, and bronchodilators, and was initiated on Budesonide/Formoterol for maintenance therapy. Within one week of ICS use, he developed white patches on the tongue and inner cheeks, oral discomfort, and dysphagia. A clinical diagnosis of oral candidiasis was made, likely secondary to ICS use in the context of diabetes-induced immunosuppression. Management included discontinuation of the ICS, initiation of topical antifungal therapy, and transition to a long-acting muscarinic antagonist (LAMA) inhaler. The patient was also educated on proper inhaler technique and the importance of rinsing the mouth after ICS use. Symptoms resolved completely within a week, and there was no recurrence at follow-up. This case underscores the importance of early recognition and management of ICS-related side effects and highlights the need for individualized COPD care, especially in patients with comorbidities that predispose them to opportunistic infections.