Surrounding superficial esophageal cancer masked by Candida esophagitis that was difficult to distinguish from Candida esophagitis alone: A case report

During the initial diagnosis of superficial esophageal squamous cell carcinoma, a 70-year-old man was treated with endoscopic submucosal dissection (ESD). Two years after the first ESD, follow-up endoscopy revealed that the extent of hyperkeratosis gradually expanded over the following 4 years; however, biopsies conducted only detected Candida mycelia and no cancer at that time and every 6 months for 4 years. Despite initiating fluconazole treatment for persistent Candida esophagitis 6 years after the first ESD, the lesions did not resolve, and the second ESD was performed 6 years after the first ESD, which revealed squamous cell carcinoma. This case highlights that esophageal cancer should be considered when localized, hyperkeratotic Candida esophagitis is unresponsive to antifungal treatments, especially with a history of esophageal cancer or high-risk factors such as drinking alcohol and smoking.