BARIUM STUDIES IN PATIENTS WITH CANDIDA-ESOPHAGITIS - PSEUDOULCERATIONS SIMULATING VIRAL ESOPHAGITIS

OBJECTIVE. The purpose of this report is to describe an abnormality id entified on barium studies in patients with Candida esophagitis that s imulates discrete or aphthous ulceration. This finding may be misinter preted as suggesting viral esophagitis. PATIENTS AND RESULTS. Between 1989 and 1993, four patients with endoscopically confirmed Candida eso phagitis 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 consisti ng of a superficial punctate barium collection surrounded by a thin ra diolucent rim. Most of the complexes were 2-3 mm in diameter. No typic al plaques were present, and the lesions were separated by normal muco sa. In two cases, only one or two lesions were observed on initial eso phagograms because of limited distension. Additional esophagograms wit h additional distension showed more lesions. In two cases, the results of the barium studies were misinterpreted as evidence of viral esopha gitis. CONCLUSION. Multiple esophageal lesions that resemble aphthous ulcers are a subtle radiographic manifestation of Candida esophagitis and may be responsible for either missed diagnoses or misinterpretatio n as viral esophagitis. Features suggestive of pseudoulceration includ e uniformity of size and relatively sharp margination of the filling d efect, and punctate rather than stellate collections of barium.