Eosinophilic esophagitis misdiagnosed twice as esophageal candidiasis.

摘要

A 56-year-old man with no previous allergic or medical history was referred because of esophageal candidiasis and persistent dysphagia despite standard treatment with fluconazole. Endoscopy revealed multiple white mucosal plaquelike lesions throughout the length of the esophagus suggestive of esophageal candidiasis, but esophageal biopsy samples showed an intense intraepithelial eosinophilic infiltration (165 eosinophils per high-power field (Eo/HPF). After a 2-month course of 20 mg rabeprazole twice daily without clinical improvement, follow-up endoscopy disclosed corrugation, white papules, and a cobblestone-like mucosa in the upper esophagus (A); subtle linear furrows, luminal narrowing and pinpoint white spots in the mid esophagus (B); and erythema, mucosal fragility, and confluent exudative white plaques in the distal esophagus (C). Biopsies confirmed the diagnosis of eosinophilic esophagitis and revealed different degrees of eosinophilic infiltration along the segments of the esophagus (upper esophagus 12 Eo/HPF, mid esophagus 56 Eo/HPF, and distal esophagus 89 Eo/HPF).