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Oesophageal aspergillosis

Oesophageal aspergillosis is predominantly seen in patients with leukaemia. It is commonly found at autopsy as part of disseminated aspergillosis, often with symptoms unrecorded during life (Young, 1970: Meyer, 1973; Kami, 2002). Localised oesophageal disease has also been described, but is rare (Yoo, 1995; Choi, 1997; Chionh, 2005). The oesophagus may also be involved by direct spread from pulmonary aspergillosis, with the development of a bronchoesophageal or tracheooesophageal fistula (Mineur, 1985; Kapelushnik, 1994). Direct extension from the oesophagus to the trachea (Obrecht, 1984), heart (Komanduri, 2002) and aorta (Nakamura, 1992) has also been reported.

Where ante-mortem diagnosis is made, patients typically present with odynophagia, epigastric pain or dysphagia. Haematemesis has also been reported (Meyer, 1973). Endoscopically either ulcers (Choi, 1997; Alioglu, 2007) or masses within the oesophagus (Asanza, 2000; Chinoh, 2005) are seen, and microscopic examination of biopsy or brushings reveals the typical dichotomously branching hyphae of Aspergillus. Co-infection with Candida or herpes simplex virus may occur (Obrecht, 1984; Asanza, 2000; Komanduri, 2002).

Treatment follows that of other forms of invasive aspergillosis, and cure has been reported in isolated oesophageal disease (Yoo, 1995; Choi, 1997; Chionh, 2005). Complicating oesophageal stenosis may respond to balloon dilatation (Alioglu, 2007). Successful surgical treatment of a tracheooesophageal fistula due to aspergillosis has also been recorded (Stack, 1997). There is one report of Aspergillus oesophagitis resolving without treatment, in a patient without immunodeficiency being treated for pneumonia (Murata, 1984).

Dr Adam Jeans

Department of Infectious Diseases and Tropical Medicine, Pennine Acute Hospitals NHS Trust,
North Manchester General Hospital,
Manchester, UK
adam.jeans@doctors.org.uk

March 2008