S2322 Esophageal Intra-Mural Pseudo-Diverticulosis With Candidiasis

Introduction: Esophageal intramural pseudo-diverticulosis (EIPD) is a rare disorder of idiopathic etiology characterized by the presence of multiple small outpouchings protruding from the esophageal lumen. Diagnosis is typically made through radiological imaging or with esophagogastroduodenoscopy (EGD). While asymptomatic by itself, symptoms arise from associated conditions including candidiasis, esophageal stricture, and chronic esophagitis. It has a male predominance and dysphagia secondary to esophageal stricture is the most common presenting complaint. Treatment is directed at associated symptomatic conditions and whether or not the diverticula disappear post treatment has no impact on the patients' clinical outcome. Case Description/Methods: This is a case of a 38-year-old male with human immunodeficiency virus (HIV) on anti-retroviral therapy. He was evaluated for a chronic history of dysphagia and odynophagia, associated with nausea, vomiting, heart burn, and weight loss. He underwent EGD which revealed pseudo-diverticula along the entirety of the esophagus with superimposed esophageal candidiasis. Patient was prescribed fluconazole 100 mg oral daily for 2 weeks and will be re-evaluated post treatment (Figure). Discussion: Dysphagia is a common presenting symptom for numerous GI conditions. Though cases of EIPD are uncommon, it is important for clinicians to keep this diagnosis in their differential. The diagnosis of EIPD may not always be apparent through EGD, as the diverticula may be small enough to miss. If a high clinical suspicion remains, radiological imaging with contrast should be considered as it has enhanced sensitivity for detecting these smaller diverticula. EIPD has been associated with Candidiasis, however it is uncertain whether it causes or is a result of the infection. In our case, we were unable to confirm whether EIPD was the cause or result of a Candida infection. Additionally, patient education is important when it comes to dysphagia. Our patient had been experiencing symptoms for 6-7 months before a diagnosis was made. It is important to educate patients that dysphagia is an abnormal symptom and should be further evaluated to determine causal etiology. There is scarce literature available regarding discussion of EIPD, therefore clinicians should continue to report cases to improve our understanding of this rare pathology.Figure 1.: Esophagogastroduodenoscopy images demonstrating esophageal intramural diverticula indicated by yellow arrows, and showing generalized esophageal candidiasis plaques present throughout the entirety of the esophagus.