Esophageal candidiasis

Background

Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.

Layers of the GI track: the mucosa, submucosa, muscularis, and serosa.

Esophagus anatomy and nomenclature based on two systems.

• Most commonly seen in HIV patients with CD4 count < 100 (AIDS-defining illness) or chronic inhaled glucocorticoid use

Clinical Features

• Odynophagia
• Dysphagia
• Retrosternal pain
• Nausea/vomiting

Differential Diagnosis

Esophagitis Types

• Inflammatory
  • GERD
  • Allergic (eosinophilic)
• Infectious Mainly seen in patients w/ immunosuppression (HIV/AIDS, cancer, steroids)
  • Esophageal candidiasis: often an AIDS defining lesion
  • HSV
  • CMV esophagitis
  • aphthous ulceration
• Medication-induced (i.e. "pill") esophagitis, common culprits:
  • Doxycycline
  • Tetracycline
  • Clindamycin
  • NSAIDs
  • ASA
  • Bisphosphonates
  • Ferrous sulfate
  • Potassium chloride
  • Ascorbic acid

HIV associated conditions

• HIV neurologic complications
  • Toxoplasmosis
  • Cryptococcosis
  • AIDS Dementia
  • Seizures in patients with HIV-AIDS
  • Primary CNS lymphoma
• HIV pulmonary complications
  • Pneumocystis jirovecii pneumonia (PCP)
  • Tuberculosis (TB)
  • CMV pneumonia
• Ophthalmologic complications
  • CMV Retinitis
  • Herpes Zoster Ophthalmicus
• Other
  • AIDS fever of unknown origin
  • Immune reconstitution inflammatory syndrome
  • HIV diarrhea
  • Esophageal candidiasis
  • Kaposi's sarcoma
  • Pruritic papular eruption of HIV
  • Hairy oral leukoplakia
• HAART medication side effects
  • HAART-induced lactic acidosis
  • Neuropyschiatric effects
  • Hepatic toxicity
  • Renal toxicity
  • Steven-Johnson's
  • Cytopenias
  • GI symptoms
  • Endocrine abnormalities

Evaluation

Esophageal candidiasis

• Thick, white, linear esophageal plaques on endoscopy

Management

• Fluconazole 400mg PO loading dose, followed by 200mg PO Qdaily x 2 weeks
• Itraconazole 200mg PO Qdaily for 2 weeks
  • has more nausea side-effects and drug interactions compared to fluconazole

Disposition

• Depends on ability to tolerate oral solids and liquids. Most patients will be dispositioned home with outpatient followup.

See Also

• AIDS