The esophagus shows areas of erythema and friability.
Pseudohyphae are easily recognized as thin noodly strands dispersed among the squamous cells.
Candida is seen in this esophageal brushing -- Note the reactive squamous cells with inflammatory perinuclear halos.
Candida is invasive into muscle fibers of the esophagus -- there are lots of inflammatory cells as well on this PAS stain.
Another case shows a brisk inflammatory exudate with necrosis. Close inspection does show some hyphae embedded in the exudate.
Numerous hyphae are seen on the corresponding GMS stain.
In normal hosts, Candidal infections generally cause oral thrush, vaginitis in women or diaper rash in babies. However, in immunocompromised hosts, Candida can cause esophagitis and disseminated disease. In systemic disease, Candida invades the bloodstream and can infect virtually every organ. Note that Candida is normal flora and often found in urine, sputum and stool cultures, but its presence in the blood is always pathogenic.
Extension of oral thrush into the esophagitis leads to esophageal candidiasis. Patients undergoing immunosuppressive therapy, chemotherapy and those with HIV are at risk. Other predisposing conditions include impaired esophageal motility (achalasia, strictures) and the congenital condition chronic mucocutaneous candidiasis.1
Usually, patients present with dysphagia and odynophagia (pain on swallowing). Since oral thrush is oftentimes associated, one may see whitish plaques distributed in the oral mucosa.
Depending on the severity of the disease, treatments include topical Nystatin (swish and swallow), antifungal medications or IV amphotericin B.
1 Vossough A, Levine MS. Esophagitis, Infectious: eMedicine. Last updated on April 16, 2009. Available at: http://emedicine.medscape.com/article/376127-overview