Clinical Presentation

An 85-year-old man who has myelodysplastic syndrome and is on prednisone presents with chest pain.

(A) Single-contrast barium study shows innumerable irregularly marginated mucosal nodules (arrows) that are linearly arranged. (B) Double- contrast study shows irregular mucosal contour (arrow) and confluent, shaggy, erosive changes throughout the esophagus (arrowheads).

Differential Diagnosis

• Candida esophagitis: This is the most likely diagnosis, given the diffuse, shaggy mucosal abnormalities and the clinical history of an elderly patient with a chronic disease being treated with steroids.