In general,
steroid is mainly used as anti-inflammatory action in case of allergic diseases. As one of the side effects of inhalation
steroid, a report is given below regarding buccal
capsule/esophageal
candidiasis. The patient came to the hospital with the chief complaint regarding passage
dysphagia in the time of deglutition;
pharyngitis and esophageal
candidiasis were found by endoscopy of upper gastrointestinal tract.The interview after the endoscopy revealed that the patient, a 69-year-old female was diagnosed as chronic
perennial allergic rhinitis a few years ago, and had been inhaling rhinenchysis
Beclometasone dipropionate (BDP) before sleep every day for the past two years because using this collunarium seemed to mitigate the
nasal obstruction and mucus during sleep. The patient did not report this fact before the endocsopy because she did not associate it with her subjective symptom. In this case, it was assumed that nebulized rhinenchysis BDP was accidentally swallowed to the pharynx and esophagus during sleep. As a treatment, rhinenchysis BDP was canceled and instead Azunol mouth washing (gargling/nasal douche) was used. No
antifungal agent was used. In two weeks, the patient reported some improvement, and this was confirmed by reexamination of the upper gastrointestinal tract using
endoscope in one month and a half.
Pharyngitis was improved, and in the digital endoscopic assessment of esophageal
candidiasis complicating inhaled
steroid therapy the esophageal
candidiasis became Grade I (mild grade). As for the later progress, the patient did not report any subjective symptoms such as
nasal obstruction and
dysphagia. In addition, the
inflammation caused by
candidiasis and found in the early examination was improved. The patient in this case was under treatment for
thrombosis in the vein of lower extremity, but no complications such as
diabetes mellitus or immune deficiency syndrome were observed.
DISCUSSION: Esophageal
candidiasis by chronic administration of inhalation of
steroid before sleep for asthmatic patients has been reported. However, there has not been a report of esophageal
candidiasis by chronic administration of rhinenchysis
steroid before sleep for patients with
allergic rhinitis. Similarly, in the case of the use of
steroid in the form of collunarium before sleep,
steroid stayed in the esophagus via the transendothelial nasal cavity, and that seemed to cause, in the long run, to develop esophageal
candidiasis.
CONCLUSIONS: One of the implications of the above case is that collunarium can go down, even when it is nebulized in the nasal cavity, to the esophagus via the nasal cavity to buccal
capsule. This suggests the necessity for preventative measures in the case of chronic administration of
steroid as follows. A. Blowing of the nose just after the use of collunarium B. Daily rinsing (gargling and nasal douche).