Severe esophageal candidiasis in a megaesophagus patient: a rare case

Megaesophagus is a largely dilated esophagus, an uncommon condition that could be the end-stage of preceding esophageal achalasia. Chronic food stasis such as in achalasia and megaesophagus could cause fungi infection in the esophagus. This report aimed to raise awareness of these rare cases. A 68-year-old male with two decades of swallowing difficulty was referred to Sardjito Hospital. Computed tomography esophagography showed megaesophagus and bird beak sign suggesting achalasia. Both esophagoscopy and esophageal tissue biopsy showed consistent results of severe esophageal candidiasis (EC). The patient was also suspected to have a mass at the distal part of the esophagus and gastric cardia, which could also contribute to the esophageal obstruction. We consulted the gastroenterologist for gastrostomy feeding and exploration of the suspected tumor. EC is known mainly in patients with immunodeficiency, while food stasis is a lesser-known cause. End-stage achalasia not only could lead to megaesophagus, but chronic food stasis is the perfect environment for fungi growth. Other causes of food stasis such as distal esophageal and gastric cardia tumors could also be the predisposition of EC. We reported a rare case of a patient with EC as a complication of megaesophagus and esophageal achalasia.