Candidiasis – Atypical Presentation in an Immunocompromised Patient: A Case Report

Candidiasis, commonly known as a “yeast infection” is an opportunistic fungal infection. Though present in normal oral microbiota, Candida can attain an infectious state in certain cases. Untreated infections can become life threatening, especially in immunocompromised individuals. Florid infections involving esophagus and distal GIT can lead to ulcerations and fungemia. Timely management of candidiasis is critical to prevent life threatening complications. Any contributing systemic conditions can make the diagnostic process elusive and challenging. A thorough knowledge of candidiasis, variations in presentation and its management strategies are instrumental in diagnosis and management. A detailed discussion on pathogenesis, various forms of oral candidiasis and their pharmacological management is beyond the scope of discussion in this case report. However, a brief classification, diagnostic tools and pharmacological management is mentioned in the discussion section. This is a clinical case of a 54-year-old female patient with intraoral white lesions referred by her primary care physician to our dental practice and also to an ENT specialist due to insurance reasons. The patient’s complex medical history has contributed to such clinical findings. Due to the limited scope of our practice, lack of access to an oral pathologist or oral medicine department within the health system and the patient’s concern about personal financial responsibility, the patient was recommended to follow up with an in insurance network ENT specialist as referred by her primary care physician. At 3 weeks follow up, ~98% of the lesions were all healed. The patient disclosed receiving treatment with Clotrimazole 10 mg troche 5 times a day for 2 weeks from an ENT specialist. From the clinical presentation, medical history, polypharmacy and positive treatment outcome, hyperplastic candidiasis was considered as the final diagnosis.