SHM Converge Scientific Abstract ePoster Gallery-Case of Esophageal Candidiasis Without Odynophagia in an Immunocompetent Patient

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This case describes a 50-year-old immunocompetent man with type 2 diabetes, hypertension, heavy alcohol use, and a 20-pack-year smoking history who presented with epigastric pain radiating to the chest, hematemesis, and a three-week history of epistaxis. Although esophageal candidiasis is typically an opportunistic infection seen in immunocompromised patients—especially those with HIV—it can also occur in non-HIV patients with risk factors such as diabetes, proton pump inhibitor use, corticosteroid exposure, cancer, smoking, and alcohol use.<br /><br />The patient’s initial evaluation was largely unremarkable. He was hemodynamically stable, had a normal CBC, HbA1c of 6.7, negative troponin, and negative HIV testing. Chest X-ray and EKG were normal, while abdominal ultrasound showed mild hepatomegaly with heterogeneous hepatic echotexture and trace ascites. Physical exam was notable only for blood around the nasal septum. Because of hematemesis, he was initially treated with ceftriaxone, octreotide, and a proton pump inhibitor, but these were discontinued after gastroenterology evaluation.<br /><br />An esophagogastroduodenoscopy (EGD) revealed diffuse esophageal candidiasis. Notably, he did not have the hallmark symptom of odynophagia, making the diagnosis more atypical. He was treated with a two-week course of oral fluconazole and discharged in stable condition.<br /><br />The key takeaway is that esophageal candidiasis should remain on the differential diagnosis in at-risk but immunocompetent patients who present with nonspecific chest or abdominal pain, since esophageal pain can be difficult to localize and symptoms may be atypical. Recognizing EC early may help prevent unnecessary or potentially harmful interventions.

Asset Subtitle

Shivanki Juneja

Meta Tag

Author List Alexander Iacobucci, Derek Nusbaum, Destiny Anamege, Doris Lin, Keith E. Liu, Michael Wilkerson, Raymond Kitziger, Shivanki Juneja

Category Clinical Vignettes

Concept Esophageal Candidiasis

Concept Fluconazole

Concept Odynophagia

Concept Diabetes Mellitus

Concept Endoscopy

Distinguished Non-Finalist

Presenter Organization Baylor College of Medicine

Presenting Author Shivanki Juneja

Track Adult

Keywords

esophageal candidiasis

immunocompetent patient

type 2 diabetes

hematemesis

epistaxis

fluconazole

esophagogastroduodenoscopy

chest pain

alcohol use

smoking history

Esophageal Candidiasis

Fluconazole

Odynophagia

Diabetes Mellitus

Endoscopy