A case of lung cancer patient suffering from severe epigastralgia turned out to be a symptom of esophageal candidiasis

Abstract

We encountered a case involving a 69-year-old man with stage IV small cell lung cancer suffering from severe epigastralgia and systemic fatigue, who was later diagnosed with esophageal candidiasis. His epigastralgia was initially thought to be derived from mediastinum lymph node metastasis. However, the use of opioid or analgesic adjuvant did not reduce his complaints, and antipsychotics were needed for unbearable pain. The pain was accompanied by heartburn and nausea that worsened when the patient was on an empty stomach. We suspected upper gastrointestinal disease. Therefore, an endoscopic examination was performed, which led to the diagnosis of esophageal candidiasis. Antifungal therapy relieved the patient's pain and improved his general condition, leading to a reduction in his opioid dose and termination of antipsychotics. The cause of painful symptoms in cancer patients may not necessarily be associated with their cancer, and thus, the actual cause of the pain should be thoroughly assessed. Early detection of any treatable cause may benefit patients with cancer even in the terminal phase.