Necrotising Candida oesophagitis after thoracic radiotherapy: significance of oesophageal wall oedema on CT

Although oesophageal candidiasis is usually a superficial mucosal infection, necrotising Candida oesophagitis has been reported to cause oesophageal perforation or lung abscess. We report the case of an elderly Japanese man presenting with painless dysphagia after thoracic radiotherapy for oesophage...

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Bibliographic Details
Published in:BMJ case reports 2015-07, Vol.2015, p.bcr2015210477
Main Authors: Saito, Hirotake, Sueyama, Hiroo, Fukuda, Takanori, Ota, Kyuma
Format: Article
Language:English
Subjects:
Abscesses
Aged
Cancer therapies
Candida - isolation & purification
Candidiasis - complications
Cytomegalovirus
Deglutition Disorders - diagnostic imaging
Deglutition Disorders - etiology
Deglutition Disorders - pathology
Diabetes
Diabetic neuropathy
Dysphagia
Edema
Endoscopy
Esophageal cancer
Esophageal Neoplasms - complications
Esophageal Neoplasms - diagnostic imaging
Esophageal Neoplasms - pathology
Esophagectomy
Esophagitis - etiology
Fatal Outcome
Findings That Shed New Light on the Possible Pathogenesis of a Disease or an Adverse Effect
Humans
Infections
Japan
Leukemia
Male
Neoplasm Recurrence, Local
Other Asian
Patients
Radiation therapy
Radiography
Sepsis
Stroke
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Summary:Although oesophageal candidiasis is usually a superficial mucosal infection, necrotising Candida oesophagitis has been reported to cause oesophageal perforation or lung abscess. We report the case of an elderly Japanese man presenting with painless dysphagia after thoracic radiotherapy for oesophageal cancer. Non-contrast CT demonstrated segmental and oedematous thickening of the oesophageal wall. Endoscopy revealed white plaques on the oesophageal mucosa. The patient's oesophagitis responded to systemic antifungal therapy, and did not lead to oesophageal perforation. He died of recurrent oesophageal cancer several months later. The importance of severe radiation-induced oesophagitis without pain, our pathophysiological hypothesis on the local oedema caused by Candida infection and the usefulness of CT in evaluating abnormal thickening of the gastrointestinal tract are discussed separately in the article.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2015-210477