Severe kodsi grade IV esophageal candidiasis in an apparently immunocompetent patient without oral thrush: A case report.

Background: Candida esophagitis is the most common fungal infection of the esophagus and typically occurs in patients with impaired immunity or other recognized predisposing conditions. Severe disease in apparently immunocompetent individuals without oral candidiasis is rare and may delay diagnosis. Case presentation: A 35-year-old previously healthy man presented with a two-month history of progressive odynophagia, cough, and unintentional weight loss. He had no history of diabetes mellitus, malignancy, chronic kidney or liver disease, corticosteroid use, broad-spectrum antibiotic exposure, proton pump inhibitor therapy, smoking, or alcohol consumption. Human immunodeficiency virus serology was nonreactive, fasting blood glucose and glycated hemoglobin were within normal limits, and examination revealed no oral candidiasis. Upper gastrointestinal endoscopy demonstrated extensive confluent whitish plaques with marked mucosal friability and luminal narrowing, consistent with severe Kodsi grade IV esophageal candidiasis on endoscopic appearance. Histopathological confirmation, fungal culture, species identification, and immunological investigations were not performed because of mucosal friability, financial limitations, and restricted diagnostic resources. The patient was treated with intravenous fluconazole and experienced rapid clinical improvement, with sustained symptomatic recovery at two-week follow-up. Conclusion: This case demonstrates that severe Kodsi grade IV Candida esophagitis may occur in apparently immunocompetent individuals without oral candidiasis or identifiable risk factors. Clinicians should maintain a high index of suspicion for esophageal candidiasis in patients with persistent odynophagia despite the absence of classical predisposing conditions. Prompt endoscopic evaluation and early antifungal therapy are critical for timely diagnosis and prevention of complications, particularly in resource-limited settings where histopathological confirmation may not be feasible.