Bacterial Ulcerative Esophagitis in an Immunocompetent Patient

Bacterial esophagitis is a very rare condition usually occurring in patients with immunosuppression. To our best knowledge, bacterial esophagitis without underlying immunosuppressive disease has not been reported. We report an immunocompetent patient with bacterial esophagitis caused by B-hemolytic Streptococcus which resulted in an esophageal stricture. A 68-year-old female was admitted for odynophagia which had developed several days before. Upper endoscopy revealed extensive ulceration covered by whitish exudates with submucosal edema at the proximal esophagus. She was treated with steroids and empirical broad-spectrum antibiotics. Within 14 days the symptoms improved. Since growth of B-hemolytic Streptococcus was detected in nasal smear culture, bacterial esophagitis was suspected. Gram staining was carried out on the already obtained tissue that had been fixed with formalin. There was heavy infiltration with gram-positive cocci morphologically consistent with Streptococcus. Since the bacterial colony was demonstrated histologically, the diagnosis of bacterial esophagitis caused by B-hemolytic Streptococcus was confirmed. In addition, complete resolution of the inflammation following antibiotics therapy was further evidence of the bacterial cause of the esophagitis.