If You Think This Is Candida, Youʼre Wrong!!!

Verrucal hyperplasia of the esophagus (VHE), a precursor to verrucous carcinoma of the esophagus (VCE), thought to be associated with Human Papilloma Virus (HPV), smoking or alcohol use. Since its discovery, less than 25 cases of VCE have been reported. The diagnosis can be very challenging due to a high prevalence of superimposed candida infection. We present a 67 year old woman with a 3 month history of progressive dysphagia and 10 pound weight loss, who had two esophagogastroduodenoscopies (EGD) preformed at an outside facility demonstrating thick, white exudates in the proximal esophagus with biopsies consistent with esophageal candidiasis and treated with antifungals, with no improvement. She denied any other symptoms, no other past medical history, no smoking, or alcohol use, no risk factors for immunosuppression and was on no medications. We performed an EGD, revealing white, verrucous plaques throughtout the esophagus. Multiple biopsies demonstrated hyperplasia but unable to rule out carcinoma, and HPV testing was negative. An endoscopic ultrasound (EUS) found a thickened esophagus, with no evidence of invasive disease or lymph node involvement, hence deep biopsies were not obtained. The patient was referred to surgery for possible esophagectomy. We are unable to label this as VCE due to the lack of deep and conclusive biopsies. Verrucal hyperplasia of the Esophagus is misdiagnosed due to lack of familiarity and candida overgrowth. EUS may be used to evaluate for penetrating disease, however the role of EUS and fine needle aspiration (FNA) for verruccal hyperplasia/carinoma is unknown. Studies have shown that esophagectomy is curative in the absence of metastatic disease. In our patient the lack of risk factors led to multiple EGDs with a misdiagnosis of Candidiasis. Our biopsies demonstrated hyperplastic changes with questionable dysplasia. This may have been due to an early diagnosis in the disease process or limited tissue on biopsy. Hence, we cannot conclusively say that she has verrucal carcinoma. However, hyperplastic changes are a know precursor to VCE and squamous cell carcinoma of the esophagus. Although very rare, and difficult to recognize due to concomitant esophageal candidiasis in most cases, it is imperative that gastroenterologists are familiar with this disease presentation even in patients with no risk factors, since early recognition is essential due to its high curative potential when recognized early in the disease process.Figure 1Figure 2Figure 3

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.