SHM Converge Scientific Abstract ePoster Gallery-Double Trouble: Combined Herpes and Candida Esophagitis in an Immunocompetent Patient

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This case describes a 44-year-old woman with ESRD and diabetes who was hospitalized for DKA and later developed nausea, vomiting, and odynophagia. After stabilization, persistent leukocytosis and swallowing pain prompted GI consultation and endoscopy. EGD showed white exudates in the esophagus consistent with Candida esophagitis, and she was discharged on fluconazole while biopsies were pending. Pathology later revealed viral inclusions diagnostic of herpes simplex esophagitis, showing that she had both Candida and HSV esophagitis.<br /><br />The report emphasizes that herpes simplex esophagitis is usually an opportunistic infection seen in patients with malignancy, AIDS, or immunosuppressive therapy, but it can rarely occur in immunocompetent individuals. Combined herpes and Candida esophagitis is especially uncommon in non-immunocompromised hosts. This patient had no clear immunodeficiency, steroid use, or other classic risk factors.<br /><br />The key message is that esophagitis in immunocompetent patients should not be assumed to be benign or due to a single cause. Endoscopy with biopsy remains the gold standard for diagnosis and is important even when endoscopic appearance suggests Candida alone, because histology may reveal a second infection such as HSV.

Asset Subtitle

Matthew Aiken

Meta Tag

Author List Matthew Aiken, Pinky Jha, Trisha Jethwa

Category Clinical Vignettes

Concept Herpes Simplex Esophagitis

Concept Esophageal Candidiasis

Concept Odynophagia

Concept Endoscopy

Concept Biopsy

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Matthew Aiken

Track Adult

Keywords

esophageal candidiasis

herpes simplex esophagitis

Candida esophagitis

odynophagia

endoscopy

esophageal biopsy

immunocompetent host

dual infection

diabetic ketoacidosis

opportunistic infection

Herpes Simplex Esophagitis

Esophageal Candidiasis

Odynophagia

Endoscopy

Biopsy