E180 UCTN – Unusual cases and technical notes Candida esophagitis complicated by esophageal stricture Fig. 1 Esophageal luminal narrowing was Fig. 2 Follow-up endoscopy performed Fig. 3 Follow-up endoscopy for the evalua- observed at 23 cm from the central incisor 6 weeks after the initial evaluation at our hos- tion of dysphagia 3 months after the initiation with irregular mucosa and multiple whitish pital showed improvement of inflammation, of treatment with a antifungal agent revealed exudates, through which the scope (GIF-H260, but still the narrowed lumen did not allow the further stenosed lumen, through which not Olympus, Japan) could not pass. passage of the endoscope. even the GIF-Q260, an endoscope of smaller caliber than the GIF-H260, could pass. A 31-year-old woman was referred to the department of gastroenterology with dys- phagia accompanied by odynophagia without weight loss. The patient was immunocompetent and her only medica- tion was synthyroid, which she had been taking for the past 15 years due to hypo- thyroidism. The patient said that she had her first recurrent episodes of odynopha- gia 7 years previously and recalled that endoscopic examination at that time had revealed severe candida esophagitis. Her symptoms improved after taking medi- cation for 1 month. She was without symptoms for a couple of years, but about 5 years prior to the current presentation, Fig. 4 Barium esophagogram demonstrated narrowing of the upper and mid-esophagus (arrows) she began to experience dysphagia from with unaffected distal esophagus. time to time when taking pills or swal- lowing meat, and these episodes had be- come more frequent and had worsened cer and pseudoepitheliomatous hyperpla- the GIF-Q260 could not pass (●" Fig. 3). during the past year. The patient visited a sia. The patient was prescribed flucona- Barium esophagogram demonstrated nar- gastroenterologist and underwent endos- zole and at follow-up endoscopy 6 weeks rowing deformity with an irregular base This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited. copy, which revealed narrowing of the later the esophageal stenosis and mucosal in the upper and mid-esophagus; the dis- esophagus and whitish plaques scattered lesion had improved. However, the lumen tal esophagus was normal (●" Fig. 4). throughout the mucosa. was still not wide enough for the GIF- Our case demonstrates the importance of The endoscopy performed at our hospital H260 to pass and only the GIF-Q260, proper and timely management of candi- also revealed esophageal luminal narrow- which has a smaller caliber, could pass da esophagitis, as inadequate and delayed ing at 23 cm from the central incisor, with through the stricture site (●" Fig. 2). treatment can result in esophageal stric- irregular mucosa and multiple ulcers and During the follow-up at the outpatient de- ture that can become debilitating. whitish exudates (●" Fig. 1). The scope partment, endoscopy was performed (GIF-H260, Olympus, Japan) could not again because the patient complained of Competing interests: None pass beyond the stricture. Multiple biop- gradual worsening of dysphagia with solid sies were taken and revealed fungal infec- foods. Endoscopic examination showed Endoscopy_UCTN_Code_CCL_1AB_2AC_3AZ tion, consistent with candidiasis, with ul- more stenotic lumen through which even Hyun JJ et al. Candida esophagitis complicated by esophageal stricture… Endoscopy 2010; 42: E180– E181 UCTN – Unusual cases and technical notes E181 J. J. Hyun, H. J. Chun, B. Keum, Y. S. Seo, Bibliography Corresponding author Y. S. Kim, Y. T. Jeen, H. S. Lee, S. H. Um, DOI 10.1055/s-0029-1244014 H. J. Chun, MD, PhD – C. D. Kim, H. S. Ryu Endoscopy 2010; 42: E180 E181 Department of Internal Medicine © Georg Thieme Verlag KG Stuttgart · New York · Institute of Digestive Disease and Nutrition Department of Internal Medicine, Institute ISSN 0013-726X Korea University College of Medicine of Digestive Disease and Nutrition, Korea 126-1, Anam-dong University College of Medicine, Seoul, 5-Ga, Seongbuk-Gu Korea Seoul Korea 136-705 Fax: +82-2-9531943 [email protected] This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited. Hyun JJ et al. Candida esophagitis complicated by esophageal stricture… Endoscopy 2010; 42: E180– E181.