Differential Diagnosis for White Nummular Lesions in Esophagus

• Single Most Likely Diagnosis
  • Candida esophagitis: This is the most common cause of white nummular lesions in the esophagus, particularly in immunocompromised patients. The lesions are typically white, raised, and can be found throughout the esophagus.
• Other Likely Diagnoses
  • Eosinophilic esophagitis: Although more commonly associated with rings, strictures, and narrowings, eosinophilic esophagitis can also present with white, exudative lesions, especially in the context of food allergies or atopic diseases.
  • Herpes simplex esophagitis: This condition can cause white or yellowish lesions, but they are often accompanied by ulcers and are more commonly seen in immunocompromised patients.
• Do Not Miss Diagnoses
  • Caustic esophagitis: While less common, caustic ingestion can lead to severe esophageal damage, including the formation of white lesions due to sloughing of the mucosa. This diagnosis is critical to identify due to its potential for severe complications, including stricture formation.
  • Esophageal carcinoma: Although rare, esophageal cancer can present with white lesions, especially if there is associated mucosal sloughing or infection. Given the high mortality rate of esophageal cancer, it is crucial not to miss this diagnosis.
• Rare Diagnoses
  • Graft-versus-host disease (GVHD): In patients who have undergone bone marrow transplantation, GVHD can affect the esophagus, leading to mucosal lesions that might appear white or ulcerative.
  • Esophageal histoplasmosis: This fungal infection can cause esophageal lesions, including white or ulcerative lesions, particularly in immunocompromised patients, though it is less common than candidiasis.
  • Esophageal lichen planus: A rare condition that can cause white, lacy lesions in the esophagus, similar to its oral counterpart. It is often associated with other mucocutaneous manifestations of lichen planus.