Abstract
The concomitant use of two distinct sampling methods can enhance the diagnostic yield of esophageal candidiasis during upper endoscopy. Furthermore, when initial staining is inconclusive, the use of additional stains can help establish the diagnosis.
Keywords: candida albicans, esophagitis, esophagoscopy, pathology
The concomitant use of two distinct sampling methods can enhance the diagnostic yield of esophageal candidiasis during upper endoscopy. Furthermore, when initial staining is inconclusive, the use of additional stains can help establish the diagnosis.
A 35‐year‐old man with HIV and a low CD 4 count presented with dysphagia and anorexia. Empirical treatment for esophageal candidiasis (EC) was initiated with fluconazole, without much improvement. Esophagogastroduodenoscopy revealed thick, confluent, and linear white plaques covering the entire esophagus (Figure 1), suggesting EC. Hematoxylin & Eosin (H&E) stain of biopsy samples were not confirmatory of EC due to extensive necrosis and background inflammation (Figure 2, panel A).
Figure 1.
Endoscopic view showing esophageal candidiasis
Figure 2.
Panel A: H&E stain showing necrotic tissue with inflammatory infiltrate. Panel B: GMS stain. Candida yeasts with pseudohyphae and/or hyphae are observed. Panel C: PAS stain showing Candida
Which sampling method can increase the diagnostic yield of esophageal candidiasis during upper endoscopy?
Cytologic brushings
Mucosal biopsy
Both
The sensitivity of brushings is significantly higher than for mucosal biopsy.1 However, brushings and biopsy are complementary and increase the diagnostic yield of endoscopic tissue sampling.1 Since poorly stained fungi may be difficult to distinguish from tissue components with H&E stain, the use of Gomori Methenamine Silver, which stains the fungal wall black or dark brown (Figure 2, panel B), is preferred for screening.2 Periodic acid‐Schiff stain may be used as well to better demonstrate the fungal morphology (Figure 2, panel C), and will stain the fungal wall pink or red‐purple.2
CONFLICT OF INTEREST
None of the authors have conflicts of interest to declare regarding this paper. No external funding source was utilized for this paper.
AUTHOR CONTRIBUTIONS
Dr Bansal: wrote the initial draft and revised the manuscript for critically important intellectual content. Dr Matos‐Casano: developed and revised the manuscript. Dr Martinez‐Pitre: assisted in procuring and editing the images.
INFORMED CONSENT
The patient provided written informed consent for the publication of the images and clinical data.
Bansal R, Matos‐Casano HA, Martinez‐Pitre P. Esophageal candidiasis and its diagnosis. Clin Case Rep. 2020;8:391–392. 10.1002/ccr3.2622
REFERENCES
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