Candida Esophagitis

Case courtesy of our radiology website partner, RiT.
Double contrast barium esophagography shows innumerable pseudomembranes and plaques (arrows) "shaggy esophagus" in a patient with AIDS.

Candida Esophagitis

* Most common cause of infectious esophagitis
* Usually opportunistic infection in immunocompromised hosts, particularly AIDS
* Can be seen in patients with esophageal stasis i.e. achalasia, scleroderma
* Absence of oral thrush does not exclude this condition! (50% of patients with Candida esophagitis do not have thrush)

Radiographic Findings

* Better with double-contrast barium esophagography (over single contrast)
* Plaque (95% of cases) > abnormal motility = thickened folds = ulcers > "shaggy" contour
* "When patients with esophageal symptoms are clinically immunosuppressed or have underlying obstructive disease of the esophagus, discrete plaque-like lesions should strongly suggest candidiasis on the double-contrast study"

Our case - fulminant Candida esophagitis.

References:
1. Levine MS, Macones AJ, Laufer I. Candida esophagitis: accuracy of radiographic diagnosis. Radiology 1985;154:581-587.
2. Levine MS, Rubesin SE. Diseases of the esophagus: diagnosis with esophagography. Radiology 2005;237:414-427.