A Striking Greenish-Yellow Endoscopic Appearance of Opportunistic Fungal Duodenitis in a Non-Human Immunodeficiency Virus (HIV) Immunocompromised Patient

Opportunistic gastrointestinal infections in immunocompromised patients can present with atypical and misleading findings. We report a renal transplant recipient on chronic immunosuppression who presented with persistent nausea, vomiting, and abdominal pain. Endoscopy revealed a striking diffuse greenish-yellow discoloration of the duodenal mucosa with friability and superficial sloughing. Histopathology demonstrated Candida species and encapsulated yeast forms suspicious for Cryptococcus despite negative serum cryptococcal antigen testing. This case highlights a potentially underrecognized endoscopic phenotype of fungal duodenitis and underscores the importance of repeat endoscopic evaluation with targeted biopsy in immunocompromised patients when initial diagnostic studies are inconclusive.