Fungal esophagitis with intractable severe cough as the main manifestation: A case report and literature review

Objective To explore the clinical features, diagnostic and therapeutic methods of fungal esophagitis with intractable severe cough as the main manifestation. Methods One case diagnosed with fungal esophagitis in our hospital was reported. The clinical characteristics, diagnosis, treatment of the patient were retrospectively analyzed and its related literatures were reviewed. Results The patient was a 36-year-old female. Her main symptoms were persistent severe cough, expectoration with intermittent fever for 7 months. With the ineffectiveness of antibiotics, antitussives and expectorants, the patient was transferred to our department. The temperature was 37.8℃. Pulmonary CT scan showed inflammatory pathological changes in the left lower lobe, and a few moist crackles were audible in the same place. The patient was diagnosed with lung infection in clinic, and then treated with levofloxacin, Tazocin to anti-infection combined with antitussives and expectorants, inhaled corticosteroid to anti-inflammatory, traditional Chinese medicine and so on. Pulmonary inflammatory lesion was absorbed and temperature became normal after careful treatments, but the symptom of severe cough was still not improved. Then the patient underwent gastroscopy and was diagnosed with candida esophagitis. The patient was treated with fluconazole to antifungal with stopping using of antibiotics and glucocorticoid at the same time. After two weeks, the symptom of cough improved obviously, and follow-up gastroscopy showed normal esophageal mucosa. Conclusion Fungal esophagitis with intractable severe cough as the main symptom is easily misdiagnosed or missed in clinical practice. The early definite diagnosis depends on gastroscopy. Antifungal agents such as Fluconazole via peripheral intravenous route are safe and efficient choices.