Pediatr Gastroenterol Hepatol Nutr.  2013 Sep;16(3):185-189. 10.5223/pghn.2013.16.3.185.

A Case of Esophageal Candidiasis in an Adolescent Who Had Frequently Received Budesonide Nebulizing Therapy

• Kang HR
• Kwon YH
• Kim YJ

• KMID: 2051332
• DOI: http://doi.org/10.5223/pghn.2013.16.3.185

Abstract

Corticosteroid (budesonide) nebulizer therapy is commonly performed. Its side effects have been considered as being safe or ignorable. The authors present a case of esophageal candidiasis in a healthy female adolescent who was treated with budesonide nebulizer therapy a few times for a cough during the previous winter season. This child presented with dysphagia and epigastric pain for 1 month. Esophageal endoscopy showed a whitish creamy pseudomembrane and erosions on the esophageal mucosa. Pathologic findings showed numerous candidal hyphae. She did not show any evidence of immunodeficiency, clinically and historically. The esophageal lesion did not resolve naturally. The esophageal lesion completely improved with the antifungal therapy for 2 weeks; the symptoms disappeared, and the patient returned to normal health. It is important that frequent esophageal exposure to topical corticosteroids application can cause unexpected side effects.

Keyword

Esophagus; Candidiasis; Budesonide; Nebulizers

MeSH Terms

Adolescent
Adrenal Cortex Hormones
Budesonide
Candidiasis
Child
Cough
Deglutition Disorders
Endoscopy
Esophagus
Humans
Hyphae
Mucous Membrane
Nebulizers and Vaporizers
Seasons
Adrenal Cortex Hormones
Budesonide

Figure

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  Fig. 1 Esophageal endoscopic finding shows creamy whitish pseudo-membranes and erosions on the whole esophageal mucosa.

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  Fig. 2 The endoscopic biopsy revealed many fungal organisms (arrows) with hyphae morphology in the hyperkeratotic squamous epithelium of the esophagus. Morphologically, this was consistent with Candida species (hematoxylin and eosin stain, ×400).

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  Fig. 3 The previously noted whitish creamy pseudo-membranes and erosions are still noted on the whole esophagus.

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  Fig. 4 Esophageal endoscopic finding shows normalized esophageal mucosa after antifungal treatment.

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