Candida esophagitis

Candida oesophagitis is the most common cause of infectious oesophagitisthat commonly affects immunocompromised patients. Clinical featureOn imaging, it is characterised by odynophagia in immune compromised patients particularly patients with AIDSirregular plaque-like lesions separated by normal mucosa and small (<1cm) ulcers, which are assessed on oesophagogram studies.

Epidemiology 

It occurs as an opportunistic infection in immune compromisedimmunocompromised patients, particularly those with AIDS, but it can also result from local oesophageal stasis caused by severe motility disorders such as scleroderma and achalasia. Only 50% patients have simultaneous oral thrush.

Clinical presentation

It is characterised by odynophagia in immunocompromised patients, particularly patients with AIDS. 

Radiographic features

Oesophagogram

On double contrast studies, it manifests as discrete longitudinally oriented linear or irregular  plaque likeplaque-like lesions separated by normal mucosa and small (<1cm) punctuate, round, or oval ulcers.

In recent years a much more fulminant form has been encountered in patients with AIDS, who may present with grossly irregular or "shaggy" oesophagus caused by innumerable coalescent pseudomembranes and plaques with trapping of barium between them. A cobblestone appearance may be visible.

Patients with scleroderma or achalasia may develop a "foamy" oesophagus. 

Differential diagnosis

Imaging differential considerations include:

• glycogenic acanthosis 
  • a condition affecting elderly people which resultsresult from the accumulation of glycogen in squamous epithelial cells lining the oesophagus.
  • this causes multiple small nodules and plaques measuring 2-10 mm in size, and of the same colour of normal mucosa. 
  • on oesophagogram, it mimics candida oesophagitis although its nodules have a more rounded appearance as apposedopposed to more linear appearing plaques in Moniliasis.moniliasis
• Cytomegaloviruscytomegalovirus esophagitis
  • causes ulcerations that may be up to 2cm2 cm wide.
• herpes oesophagitis
• HIV esophagitisoesophagitis