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Serial biopsies showed parakeratosis/hyperkeratosis without dysplasia or malignancy, with intermittent Candida. Imaging showed no mass, so management used high-dose acid suppression, short fluconazole courses, and zinc/riboflavin supplementation, plus planned manometry and surveillance endoscopy.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/persistent-esophageal-parakeratosis-with-recurrent-candida-esophagitis-in-a-virally-suppressed-person-with-hiv-case-report/408663/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/persistent-esophageal-parakeratosis-with-recurrent-candida-esophagitis-in-a-virally-suppressed-person-with-hiv-case-report/408663.png","ImageObject",300,407,{"name":42,"@type":43},"dawugda","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-31","2026-09-28",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",10,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What histologic finding defines esophageal parakeratosis in this report?","Question",{"text":63,"@type":64},"It is characterized by parakeratosis/hyperkeratosis on serial biopsies, without dysplasia or malignancy, despite malignant-appearing endoscopic plaques.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How did Candida esophagitis factor into the patient’s condition?",{"text":68,"@type":64},"Intermittent Candida was detected on histology, and short courses of fluconazole improved symptoms during episodes.",{"name":70,"@type":61,"acceptedAnswer":71},"Why was repeat histology and careful follow-up emphasized?",{"text":72,"@type":64},"Because endoscopic appearance closely mimicked malignancy, repeat biopsies and cross-sectional imaging helped rule out cancer; surveillance endoscopy and further evaluation were planned given ongoing symptoms.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},408663,1790862394,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,120,123,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":116,"doc_module":4,"doc_module_name":25,"category_name":117,"show_sort_weight":118,"slug":119},9,"Religion & Spirituality",20,"religion-spirituality",{"id":118,"doc_module":4,"doc_module_name":25,"category_name":121,"show_sort_weight":118,"slug":122},"World Cup","world-cup",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":55,"slug":125},"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":97,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":111,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":143,"read_time":118,"preview_page_count":4},3985747870947,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","Review began 10/22/2025  \nReview ended 11/27/2025  \nPublished 12/01/2025  \n© Copyright 2025  \nHama-Salih et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CCBY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98257  \nOpen Access Case Report  \nPersistent Esophageal Parakeratosis With Recurrent Candida Esophagitis in a Virally Suppressed Person With HIV  \nRizgar Hama-Salih 1, Mohammad Alsaadony 2, Kushal Panja 3 , Deepa Bai 4, Madiha Erashdi 5, Emil Salmo 6  \n1. Gastroenterology, Tameside Hospital, Tameside and Glossop Integrated Care NHS Foundation Trust, Manchester, GBR 2. General Internal Medicine, North Manchester General Hospital, Manchester University NHS Foundation Trust, Manchester, GBR 3. General Medicine, North Manchester General Hospital, Manchester University NHS Foundation Trust, Manchester, GBR 4. General Medicine, Manchester University NHS Foundation Trust, Manchester, GBR 5. Pathology, Liverpool University Hospital NHS Foundation Trust, Liverpool, GBR 6. Pathology, Royal Oldham Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, GBR  \nCorresponding author: Mohammad Alsaadony, [dr.mohammadali@hotmail.com](dr.mohammadali@hotmail.com)  \nAbstract  \nEsophageal parakeratosis is an uncommon histopathologic finding that can closely mimic malignancy endoscopically and has been linked to micronutrient deficiency states and chronic reflux. We report a 57-year-old man with well-controlled HIV (stable viral suppression and robust CD4 count) who developed progressive dysphagia with malignant-appearing esophageal plaques over a long segment of the mid-todistal esophagus. Serial biopsies repeatedly showed parakeratosis/hyperkeratosis without dysplasia or malignancy, with intermittent Candida on histology. Despite the alarming appearance, cross-sectional imaging revealed no mass or nodal disease. Management included high-dose acid suppression, short courses of fluconazole for Candida esophagitis, and empiric zinc and riboflavin supplementation; the endoscopic extent of keratinization reduced but persisted, and dysphagia fluctuated without a fixed stricture. Given ongoing symptoms and easy passage of the scope, esophageal manometry was arranged to evaluate a motility contribution, and surveillance endoscopy was planned. This case emphasizes the importance of repeat histology before committing to oncologic pathways, consideration of micronutrient supplementation, cautious use of long-term proton-pump inhibition in patients at risk for Candida, and individualized surveillance where formal guidance is lacking.  \nCategories: Pathology, Internal Medicine, Gastroenterology  \nKeywords: candida esophagitis, dysphagia, esophageal parakeratosis, esophagogastroduodenoscopy, hiv, ogd  \nIntroduction  \nEsophageal parakeratosis is a rare finding characterized histologically by a hyperkeratinized squamousepithelium with retained pyknotic nuclei, often presenting endoscopically as white plaques or thickened mucosa that can closely mimic dysplasia or early neoplasia [1] . In the limited case literature, some reports have linked its development to micronutrient deficiencies, particularly riboflavin and zinc, and observed partial regression after repletion [2,3] .  \nCandida esophagitis (CE), classically associated with immunocompromise, is increasingly recognized among patients without profound immunosuppression. In a cohort of “immunocompetent” patients, proton-pump inhibitor (PPI) use was identified as the most common associated risk factor (odds ratio (OR) ~1 .69) [4] . A larger Japanese cross-sectional study of 7,736 patients undergoing endoscopy found PPI use (OR 1.69), diabetes, atrophic gastritis, and gastrectomy to be independent risk factors for CE even in patients without overt immunodeficiency [5] . In a clinical series, 63-81% of esophageal candidiasis","cbCaicPJVOqvZL1P","https://ap.wps.com/l/cbCaicPJVOqvZL1P","pdf",4525311,"English","# Abstract\n# Introduction\n# Case Presentation\n## Diagnosis and Key Findings\n## Management and Follow-up","[{\"question\":\"What histologic finding defines esophageal parakeratosis in this report?\",\"answer\":\"It is characterized by parakeratosis/hyperkeratosis on serial biopsies, without dysplasia or malignancy, despite malignant-appearing endoscopic plaques.\"},{\"question\":\"How did Candida esophagitis factor into the patient’s condition?\",\"answer\":\"Intermittent Candida was detected on histology, and short courses of fluconazole improved symptoms during episodes.\"},{\"question\":\"Why was repeat histology and careful follow-up emphasized?\",\"answer\":\"Because endoscopic appearance closely mimicked malignancy, repeat biopsies and cross-sectional imaging helped rule out cancer; surveillance endoscopy and further evaluation were planned given ongoing symptoms.\"}]","Persistent Esophageal Parakeratosis With Recurrent Candida Esophagitis in a Virally Suppressed Person With HIV - Case Report | PDF",1790580147]