Corticosteroid-Induced Candida Albicans Colonization of an Intragastric Balloon: A Case Report and Literature Review

Background: Intragastric balloons (IGBs) are temporary endoscopic devices used for weight management in patients with obesity; while bacterial colonization of IGBs is well recognized, fungal infection remains rarely reported. Case Presentation: We describe a 24-year-old male who developed candidal infection of an intragastric balloon after completing a 14-day course of dexamethasone (8 mg daily), equivalent to approximately 53 mg of prednisone daily, prescribed for presumed allergic rhinitis. Six weeks after balloon placement for obesity management (body mass index [BMI]: 37.2 kg/m²), he presented with epigastric discomfort, nausea, and intermittent vomiting. Upper gastrointestinal endoscopy revealed extensive white-cream fungal plaques covering the balloon surface with mild surrounding mucosal erythema. Microbiological analysis of gastric aspirate confirmed Candida albicans (>10⁵ colony-forming units [CFU]/mL) on culture, with positive potassium hydroxide (KOH) preparation and Periodic Acid-Schiff (PAS) staining. The balloon was removed endoscopically and the patient was treated with fluconazole (400 mg loading dose, then 200 mg daily for 14 days), with complete symptom resolution within five days and eradication confirmed on repeat endoscopy and culture at four weeks. Conclusion: This case illustrates that even short-term corticosteroid therapy can predispose patients with an indwelling IGB to opportunistic fungal colonization. Clinicians should maintain a high index of suspicion for fungal infection in IGB patients who develop new gastrointestinal symptoms during or after immunosuppressive therapy, and early endoscopic evaluation, balloon removal, and antifungal therapy achieve favorable outcomes.