Esophageal candidiasis differential diagnosis

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 (e.g. herpes simplex esophagitis, CMV esophagitis)

Differentiating esophageal candidiasis from other diseases

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

	Prominent clinical features	Endoscopy findings
Candida esophagitis	Odynophagia is the most prominent symptom May be accompanied by oropharyngeal candidiasis	Endoscopy shows characteristic white yellowish lesions over the mucosa.	Endoscopic image of esophageal candidiasis in a patient after chemotherapy - arrows indicating the candida lesions
HSV esophagitis	HSV esophagitis is due to reactivation of HSV usually in immunocompromised patients. HSV esophagitis usually presents acutely as dysphagia, odynophagia accompanied by fever and other constitutional symptoms. Oropharyngeal vesicles and ulcers may accompany 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.	Herpes esophagitis - arrows indicating herpetic ulcers - By Donald E. Mansell, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=9666173
CMV esophagitis	CMV esophagitis is characterized by more insidious onset of nausea, vomiting, dysphagia and consequent weight loss. CMV esophagitis occurs more commonly in organ transplant patients more than in HIV patients.	As in 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 esophageal necrosis with no ulcers.
Esophageal lymphoma	Esophageal lymphoma has nonspecific symptoms of dysphagia, hoarseness and  retrosternal chest pain.	Endoscopy is useful in obtaining biopsies as visual findings are not specific as lymphoma can be accompanied by candidiasis or HSV esophagitis.

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

• Gastroesophageal reflux disease (GERD)
• Barrett's esophagus
• Esophageal achalasia
• Pill esophagitis
• Eosinophilic esophagitis