Does esophageal candidiasis cause punctate mucosal bleeding when scraped?

Esophageal Candidiasis and Mucosal Bleeding When Scraped

Yes, esophageal candidiasis does cause punctate mucosal bleeding when scraped during endoscopic examination. This characteristic is an important diagnostic feature of esophageal candidiasis, as the white plaques adhere firmly to the mucosa and when scraped or manipulated during endoscopy, can reveal underlying mucosal inflammation and cause punctate bleeding.

Clinical Characteristics of Esophageal Candidiasis

Esophageal candidiasis presents with distinctive endoscopic findings:

• Whitish plaques similar to those observed in oropharyngeal candidiasis 1
• Adherent lesions that cannot be washed off with water irrigation 2
• Plaques that may progress to superficial ulceration of the esophageal mucosa 1
• Central or surface whitish exudates on the mucosa 1

When these plaques are scraped during endoscopic examination or biopsy, the underlying inflamed mucosa often shows punctate bleeding due to the invasive nature of the fungal infection, which damages the mucosal integrity.

Diagnostic Approach

The diagnosis of esophageal candidiasis requires:

1. Endoscopic visualization of characteristic white plaques 1, 2
2. Histopathologic demonstration of Candida yeast forms in tissue 1
3. Culture confirmation of Candida species 1

During endoscopy, the following features help distinguish esophageal candidiasis:

• White nummular lesions or plaques that adhere to the mucosa 2
• Plaques that cannot be washed away with water irrigation 2
• Punctate bleeding when these plaques are scraped or manipulated
• Possible progression to superficial ulceration in more severe cases 1

Clinical Presentation

Patients with esophageal candidiasis typically present with:

• Retrosternal burning pain or discomfort 1
• Odynophagia (painful swallowing) 1, 2
• Dysphagia (difficulty swallowing) 2
• Food avoidance behavior 2
• Drinking large volumes of water with meals as a compensatory behavior 2

Risk Factors

Esophageal candidiasis is most commonly seen in:

• Immunocompromised patients, particularly those with CD4+ counts <200 cells/µL 1, 2
• HIV/AIDS patients 2
• Patients on long-term antibiotic therapy 2
• Patients receiving corticosteroids, radiation, or chemotherapy 2
• Patients with esophageal motility disorders 2
• Diabetics 2

Clinical Significance of Mucosal Bleeding

The presence of punctate bleeding when esophageal candidiasis plaques are scraped has diagnostic significance:

• Confirms the invasive nature of the infection
• Distinguishes it from other whitish lesions that may not bleed when scraped
• Indicates mucosal inflammation and potential tissue damage
• May correlate with disease severity in some cases

This characteristic bleeding pattern, along with the typical appearance of adherent white plaques, helps clinicians differentiate esophageal candidiasis from other conditions such as cytomegalovirus esophagitis, herpes simplex virus esophagitis, or eosinophilic esophagitis during endoscopic examination.