CASE 3745 Published on 17.06.2005

Candida oesophagitis

Section

Abdominal imaging

Case Type

Clinical Cases

Authors

Henrique Rodrigues; Pedro Belo Oliveira; Paulo Donato; José Ilharco

Patient

55 months, female

Clinical History
Authors describe a case of a 40 years old female, immunocompromised with less than 100 CD4, that presented complains of dysphagia and odynophagia. Barium oesophagography showed a long segment in the upper with reduced distensibility and profound linear ulcerations. Endoscopy and biopsies confirmed the diagnosis of candida oesophagitis.
Imaging Findings
The 40 years old female with AIDS and less than 100 CD4 was referred to hospital urgency with complains of dysphagia and odynophagia. At physical examination patient look wasted, dehydrated, and with skin pallor. Laboratory data at urgency room showed anaemia, reduced leukocyte count, and elevated PCR. In single contrast oesophagography we observed a long segment in the upper third of the oesophagus with reduced distensibility, tapered margins and profound linear ulcerations, giving a cobblestone appearance (Fig 1; Fig 2). At endoscopy white plaques with an eritematous background were observed, and later biopsies results confirmed the presence of Candida spores and hiphae. Successful therapeutic with intravenous amphotericin B was performed.
Discussion
Candida oesophagitis most frequently develops in immunocompromised patients but occasionally it complicates food stasis in patients with achalasia or peptic stricture [1]. Candida oesophagitis may occur without oral thrush. The double contrast oesophagogram has a reported sensitivity of approximately 90% for detecting Candida oesophagitis [2]. The double-contrast oesophagogram may show linear, elevated, 2–3 mm plaque-like lesions which correspond to the characteristic white fungal plaques found at endoscopy. These frequently tend to line up along the long axis of the oesophagus with intervening segments of normal mucosa [2]. Occasionally, instead of plaques or nodules, a punctate barium collection surrounded by a radiolucent rim may be seen [3]. In severe Candida infection the oesophagus develops a cobblestone appearance and on single-contrast views the margins become shaggy and irregular. Oesophageal fold thickening and a loss of distensibility may also be present [4]. Motility disturbances range from intermittent absence of the primary peristaltic complex to tonic contraction of the entire oesophagus with episodes of segmental spasm [4].
Differential Diagnosis List
Candida oesophagitis
Final Diagnosis
Candida oesophagitis
Case information
URL: https://www.eurorad.org/case/3745
DOI: 10.1594/EURORAD/CASE.3745
ISSN: 1563-4086