Delayed healing of a gastric ulcer due to Candida infection following vonoprazan therapy: a case report

An 89-year-old woman presented with hematemesis, and endoscopic examination revealed a hemorrhagic gastric ulcer in the lesser curvature near the cardia. After successful endoscopic hemostasis, vonoprazan was initiated, and the patient was discharged. On follow-up endoscopy on day 57, a yellowish-white exudate was observed at the base of the ulcer. Histological examination confirmed Candida infection. Oral miconazole was initiated, and by day 119, the ulcer healed. Although gastric candidiasis is rare, it may occur not only as an opportunistic infection but also due to low gastric acidity caused by acid-suppressive agents. In this case, vonoprazan likely contributed to Candida overgrowth and delayed healing. Therefore, clinicians should consider the risk of secondary Candida infections when using potent acid suppressants.