Unveiling Esophageal Candidiasis

Abstract

Esophageal candidiasis (EC) occurs more commonly in patients with human immunodeficiency virus (HIV) in the AIDS stage (CD4+ counts < 100 cells/ml). Other conditions of immunosuppression in which EC is more frequent include hematological malignancies, particularly receptors of hematopoietic precursors, solid cancers undergoing chemotherapy, and, less frequently, primary defects of the immune system. Although infrequent, EC can also occur in immunocompetent individuals. In these cases, the risk is higher in users of proton pump inhibitors, high-dose inhaled corticosteroids, and smokers. The differential diagnosis includes other opportunistic infections (Cytomegalovirus, herpes simplex virus), drug esophagitis, gastroesophageal reflux disease, and/or eosinophilic esophagitis. The clinical case presented aims, above all, to raise awareness of the multiplicity of etiologies of EC and not, as was the case in the past, to classify it as an AIDS-defining disease.

Keywords: esophageal candidiasis; esophagitis; human immunodeficiency virus infection; immunodeficiency; systemic mastocytosis.

Figure 1. Upper gastrointestinal endoscopy.

Whitish plaques were noted, suggestive of esophageal candidiasis, which were non-removable with a water jet.

Figure 2. Abdominal ultrasound (A).

Liver with elongated morphology (16.5 cm), regular contours, and homogeneous parenchyma. Thin-walled gallbladder, without lithiasis. No dilatation of the bile ducts. The yellow asterisks represent the longitudinal length of the liver.

Figure 3. Abdominal ultrasound (B).

The spleen had normal dimensions (10.3 cm), regular contours, and homogeneous parenchyma. The yellow asterisks represent the longitudinal length of the spleen.

Figure 4. Gynecological ultrasound.

Gynecological ultrasound revealed two adnexal cysts on the left measuring 2.7 and 3.7 cm, of simple appearance, probably functional.