Esophageal candidiasis differential diagnosis: Difference between revisions

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__NOTOC__
{{Esophageal candidiasis}}
{{CMG}};{{AE}}{{AY}}


==Overview==
Esophageal candidiasis should be differentiated from other diseases causing [[dysphagia]] especially in [[Immunocompromised|immunocompromised patients]].
==Differentiating esophageal candidiasis from other diseases==
{| class="wikitable"
!
!Prominent clinical featurs
!Endoscopy findings
!
|-
|Candida esophagitis
|
* [[Odynophagia]] is the most prominent symptom
* May be accompanied by [[oropharyngeal candidiasis]]
|
* [[Endoscopy]] shows characteristic white yellowish lesions over the [[Mucous membrane|mucosa.]]
|
|-
|[[HSV|HSV esophagitis]]
|
* [[HSV|HSV esophagitis]] is due to reactivation of [[HSV]] usually in [[Immunocompromised|immunocompromised patients]].
* [[HSV|HSV esophagitis]] usually presents acutely as [[dysphagia]], [[odynophagia]] accompanied by [[fever]] and other constitutional symptoms.
* [[Vesicles|Oropharyngeal vesicles]] and [[ulcers]] may accompany [[HSV|HSV esophagitis]].<ref name="pmid8686361">{{cite journal |vauthors=Becker K, Lübke HJ, Borchard F, Häussinger D |title=[Inflammatory esophageal diseases caused by herpes simplex virus infections--overview and report of 15 personal cases] |language=German |journal=Z Gastroenterol |volume=34 |issue=5 |pages=286–95 |year=1996 |pmid=8686361 |doi= |url=}}</ref>
|
* [[HSV]] lesions are usually present in the distal esophagus. Lesions start as [[vesicles]] but later on coalesce and form large [[ulcers]].
* [[Ulcers]] are 8-10 mm in size, has a volcano like appearance and covered with a white exudate.
|
|-
|[[CMV esophagitis (patient information)|CMV esophagitis]]
|
* [[CMV esophagitis (patient information)|CMV esophagitis]] is characterized by more insidious onset of [[nausea]], [[vomiting]], [[dysphagia]] and consequent [[weight loss]].
* [[CMV esophagitis (patient information)|CMV esophagitis]] occurs more commonly in [[organ transplant]] patients more than in [[Human Immunodeficiency Virus (HIV)|HIV]] patients.
|
* As in [[HSV|HSV esophagitis]], [[CMV]] lesions are usually in the distal esophagus.
* Lesions can be  multiple small [[ulcers]] or large single shallow ulcer.
* [[CMV]] esophagitis can present as [[Necrosis|esophageal necrosis]] with no ulcers.<ref name="pmid2823585">{{cite journal |vauthors=Balthazar EJ, Megibow AJ, Hulnick D, Cho KC, Beranbaum E |title=Cytomegalovirus esophagitis in AIDS: radiographic features in 16 patients |journal=AJR Am J Roentgenol |volume=149 |issue=5 |pages=919–23 |year=1987 |pmid=2823585 |doi=10.2214/ajr.149.5.919 |url=}}</ref>
|
|-
|[[Lymphoma|Esophageal lymphoma]]
|
* [[Lymphoma|Esophageal lymphoma]] has nonspecific symptoms of [[dysphagia]], [[hoarseness]] and  [[Chest pain|retrosternal chest pain]].
|
* [[Endoscopy]] is useful in obtaining [[biopsies]] as visual findings are not specific as [[lymphoma]] can be accompanied by [[candidiasis]] or [[HSV|HSV esophagitis]].<ref name="pmid21160688">{{cite journal |vauthors=Ghimire P, Wu GY, Zhu L |title=Primary esophageal lymphoma in immunocompetent patients: Two case reports and literature review |journal=World J Radiol |volume=2 |issue=8 |pages=334–8 |year=2010 |pmid=21160688 |pmc=2999330 |doi=10.4329/wjr.v2.i8.334 |url=}}</ref>
|
|}
Candida esophagitis should also be differentiated from other causes of dysphagia as:
*[[Gastroesophageal reflux disease]] (GERD)
*[[Barrett's esophagus]]
*[[Esophageal achalasia]]
*[[Esophagitis|Pill esophagitis]]
*[[Eosinophilic esophagitis]]
==References==
{{reflist|2}}

Revision as of 20:36, 28 May 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]

Overview

Esophageal candidiasis should be differentiated from other diseases causing dysphagia especially in immunocompromised patients.

Differentiating esophageal candidiasis from other diseases

Prominent clinical featurs Endoscopy findings
Candida esophagitis
HSV esophagitis
  • HSV lesions are usually present in the distal esophagus. Lesions start as vesicles but later on coalesce and form large ulcers.
  • Ulcers are 8-10 mm in size, has a volcano like appearance and covered with a white exudate.
CMV esophagitis
Esophageal lymphoma

Candida esophagitis should also be differentiated from other causes of dysphagia as:

References

  1. Becker K, Lübke HJ, Borchard F, Häussinger D (1996). "[Inflammatory esophageal diseases caused by herpes simplex virus infections--overview and report of 15 personal cases]". Z Gastroenterol (in German). 34 (5): 286–95. PMID 8686361.
  2. Balthazar EJ, Megibow AJ, Hulnick D, Cho KC, Beranbaum E (1987). "Cytomegalovirus esophagitis in AIDS: radiographic features in 16 patients". AJR Am J Roentgenol. 149 (5): 919–23. doi:10.2214/ajr.149.5.919. PMID 2823585.
  3. Ghimire P, Wu GY, Zhu L (2010). "Primary esophageal lymphoma in immunocompetent patients: Two case reports and literature review". World J Radiol. 2 (8): 334–8. doi:10.4329/wjr.v2.i8.334. PMC 2999330. PMID 21160688.