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,