Concomitant herpes-monilial esophagitis: case report with ultrastructural study

Herpesvirus and Candida albicans are each well-known pathogens associated with esophagitis, and concomitant infections by both agents are occasionally observed. The case of a 58-year-old man who had been treated for carcinoma of the tonsil and died of confluent bronchopneumonia is presented. Autopsy revealed an esophagitis in which cytologic changes of viral infection were seen in the intact esophageal epithelium along with pseudomycelia of Candida albicans within the ulcer bed. In addition, ultrastructural study showed dual infection by Candida and herpesvirus within individual esophageal epithelial cells at the ulcer edge, a unique demonstration of coexistent intracellular infection.