Necrotizing Candida esophagitis. Failure of symptoms and roentgenographic findings to reflect severity.

REPORTS of necrotizing Candida esophagitis have been limited to patients receiving intensive chemotherapy for malignant neoplasms, prolonged treatment with corticosteroids, or broad-spectrum antimicrobial agents. 1-4 Patients have dysphagia or odynophagia, and these symptoms have been used to evaluate response to treatment of the infection. There is agreement that a barium esophagram done early in the course of Candida esophagitis shows nodular filling defects imprinting the edge of the barium column. 5 Esophagrams late in the course of the infection have been described as showing a very shaggy appearance of the esophageal lining. 1-6 The latter is thought to reflect deep ulcerations of the mucosa. Severe Candida esophagitis developed in the patient described here following a course of chemotherapy. After three weeks of antifungal therapy, odynophagia and dysphagia were gone and a barium esophagram was nearly normal in appearance; however, when the patient died suddenly a few days later, autopsy showed