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

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.

Prevalence, Predictive Factors, and Clinical Manifestations of Fungal Esophagitis in Children

“…To our knowledge, this is the largest pediatric study investigating the association between topical swallowed corticosteroids and FE. Topical swallowed corticosteroids are often used in children for the treatment of EoE and have been hypothesized to have a more potent immunosuppressive effect on the esophageal mucosa (37–39). This study emphasizes the importance of monitoring topical corticosteroid use in children to minimize the risk of FE.…”