Barium studies in patients with Candida esophagitis: pseudoulcerations simulating viral esophagitis

The purpose of this report is to describe an abnormality identified on barium studies in patients with Candida esophagitis that simulates discrete or aphthous ulceration. This finding may be misinterpreted as suggesting viral esophagitis.

Between 1989 and 1993, four patients with endoscopically confirmed Candida esophagitis and no evidence of associated viral infection were treated at Hahnemann University. These patients were selected for study because double-contrast barium studies showed an "aphthoid" complex consisting of a superficial punctate barium collection surrounded by a thin radiolucent rim. Most of the complexes were 2-3 mm in diameter. No typical plaques were present, and the lesions were separated by normal mucosa. In two cases, only one or two lesions were observed on initial esophagograms because of limited distension. Additional esophagograms with additional distension showed more lesions. In two cases, the results of the barium studies were misinterpreted as evidence of viral esophagitis.

Multiple esophageal lesions that resemble aphthous ulcers are a subtle radiographic manifestation of Candida esophagitis and may be responsible for either missed diagnoses or misinterpretation as viral esophagitis. Features suggestive of pseudoulceration include uniformity of size and relatively sharp margination of the filling defect, and punctate rather than stellate collections of barium.