13例恶性血液病并发真菌性食管炎患者的临床分析

OBJECTIVE: To improve the clinical understanding of fungal esophagitis in patients with hematologic malignancies. METHODS: The clinical data of a cohort of 279 patients with hematologic malignancies who underwent gastroscopy between 2012 and 2015 in the Endoscopy Center of Henan Tumor Hospital were retrospectively analyzed. To investigate the clinical characteristics and prognosis of fungal esophagitis in patients with heratologic malignancies. RESULTS: 13 of the 279 patients were diagnosed as fungal esophagitis (4.66%). C. albicans was prevalent (12/13), and only 1 case was cryptococcus. All of the 13 patients had lymphatic systemic diseases (8 cases with diffuse large B cell lymphoma, 1 with peripheral T-cell lymphoma, 2 with acute lymphoblastic leukemia, and 1 with multiple myeloma). 6 patients had gastrointestinal symptoms (3 cases with nausea and anorexia as well as the sentation of having a foreign body in pharyngeal, 2 cases with pain or a burning sensation behind the sternum, and 1 case having difficulty or pain when swallowing), while 7 patients had no obvious manifestations. 6 patients accepted fluconazole 400 mg/d for 2 weeks and achieved satisfactory results; Meanwhile 7 cases were given nystatin 1 million uint 3 times a day for 2 weeks, of which 6 cases responded well, and 1 case was not relieved until he was given fluconazole 400 mg/d for 1 week. Treatmentassociated adverse events included mildly elevated aminotransferase (1 case) and mild gastrointestinal adverse reaction (1 case). CONCLUSION: The fungal esophagitis in patients with hematologic malignancies was not rare. Most of those patients had lymphatic systemic diseases and the main pathogen was candida albicans. The clinical manifestations of fungal esophagitis were quite atypical and about more than half of those patients had no gastrointestinal symptoms. Either fluconazole or nystatin was safe and effective treatment with slight adverse reactions.