Diagnosis
Painful swallowing.
Epidemiologic Risks
Usually immunocompromised: HIV or chemotherapy.
Occasionally normal people get Herpes esophagitis with their first case of cold sores.
Microbiology
Candida (C. albicans and, in patients on long term fluconazole, nonalbicans Candida), Herpes (can occur in the normal host), CMV are the big three.
A hodgepodge of other organisms has been reported.
There are also a large number of non-infectious causes. Yawn.
Empiric Therapy
Depends on the diagnosis, might I suggest a diagnostic test, say, endoscopy, before embarking on a course of therapy? Might I? Please? Occasionally AIDS patients are treated with empiric fluconazole and then endoscoped if symptoms persist.
Pearls
Patients with Candida esophagitis do not necessarily have Candida in the mouth. But. In HIV, oral thrush has a sensitivity of 53% and a positive predictive value of 77% for Candida esophagitis (PubMed) .
The British, amusingly, misspell it oesophagitis.
Rants
Last Update: 07/10/18.