1891 Esophageal Intramural Pseudodiverticulosis and Concomitant Esophageal Candidiasis

Abstract

INTRODUCTION: This case pertains to a 65 yo AA M who presented with chronic dysphagia. Multiple EGDs were performed and Esophageal Intramural Pseudodiverticulosis (EIP) was noted along with Esophagitis, strictures and esophageal candidiasis. Esophageal Pitting, or EIP, is described as longitudinal rows of multiple small flask-shaped outpouchings protruding from the esophagus (1,4). Although EIP is not particularly prevalent, esophageal candidiasis is found in 50% of these cases (1). Consisely, clinicians should be aware of EIP and it’s strong association with dysphagia, strictures, and esophageal candidiasis, as such, biopsies should be taken on EGD. CASE DESCRIPTION/METHODS: 65 yo AAM, with significant PMHx of IDDM and GERD, presented with chronic dysphagia (pills and solid food). On presentation, patient denied any other GI or chest complaints. Patient underwent EGD: Numerous pits were seen in the mid esophagus [Figure 1]. Multiple biopsies were taken and pathology demonstrated fragments of esophageal mucosa with acute esophagitis and yeast forms were identified. Patient also had distal esophageal stricture, which was balloon dilated. He was then lost to follow up. Several years later he returned with dysphagia. On Repeat EGD, diffuse esophageal pitting was seen from 25 cm to the EGJ [Figure 2]. Pathology demonstrated acute esophagitis with focal fungal elements [Figure 3]. No malignancy was seen. Patient was started on appropriate antifungal and daily PPI. Repeat EGD was scheduled for 3 months. DISCUSSION: EIP, as noted in our patient, although a rare finding, can be seen in patient’s with Dysphagia (1). 80% of symptomatic patients present with intermittent or progressive dysphagia (1,3). Etiology of EIP to date is unclear. Some association has been seen with inflammatory disease of the esophagus (chronic esophagitis or infectious) (1–4). Management focuses on symptomatic relief along with treating the underlying disease (1,3).