Candidiasis threatening airway

We discussed a 48 yo M with HIV who was admitted for progressive worsening pain and swelling of his throat and neck with odynophagia over the preceding couple of mos but worse over the past 2 weeks. He was seen at an outside clinic 10 days prior to this for similar symptoms and treated with antibiotics and a steroid taper (for unclear reasons).

His symptoms got worse over time and he was admitted with diffusely inflamed, erythematous oropharynx, palatine tonsils, epiglottis and larynx (seen on laryngoscopic exam, soft tissue neck films and CT). He apparently had both types of candidiasis; erythematous and pseudomembranous with near airway compromise.

Take home points:

– Absence of white plaques does not exclude Candidiasis. On his first presentation this was likely why the diagnosis of candiasis was not made. Candidiasis can be of different types and two of the major types being pseudomembranous (with white creamy plaques)  and chronic erythematous (with just erythema and inflammation).

– Candidiasis can be severe enough to cause laryngeal edema threatening airway.

– Remember the neck fascial spaces and cervical lymph node groups.

Reference papers: Oropharyngeal candidiasis in HIV,  Candidial esophagitis.