Candida esophagitis

Candida oesophagitis is the most common cause of infectious oesophagitis that commonly affects immunocompromised patients. On imaging, it is characterised by irregular plaque-like lesions separated by normal mucosa and small (<1 cm) ulcers, which are assessed on oesophagogram studies.

Epidemiology

It occurs as an opportunistic infection in immunocompromised 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% of 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 orientedorientated linear or irregular plaque-like lesions separated by normal mucosa and small (<1 cm) punctuate, round, or oval ulcers.

In recent years aA much more fulminant form of Candida oesophagitis has been encountered in patients with AIDS, who may present with grossly irregular or "shaggy"shaggy" oesophagus caused by innumerable coalescent pseudomembranes and plaques with trapping of barium between them. A cobblestonecobblestone appearance may 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 result from the accumulation of glycogen in squamous epithelial cells lining the oesophagus

  • 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 opposed to more linear appearing plaques in moniliasis

• cytomegalovirus oesophagitis

  • causes ulcerations that may be up to 2 cm wide

• herpes oesophagitis

• HIV oesophagitis