Dysphagia, Hyperglycemia, and Presyncope

Dysphagia. 2018 Dec;33(6):866-868. doi: 10.1007/s00455-018-9932-5. Epub 2018 Jul 30.

Abstract

There have been over 80 documented cases of swallow syncope-a rare form of reflex or neurally mediated syncope-with most cases associated with an underlying esophageal disorder. Here, we describe the first reported case of swallow syncope or presyncope caused by an infectious esophagitis. Our 65-year-old patient initially developed dysphagia, odynophagia, and presyncope with swallowing. This lead to nutrition and medication avoidance behavior, which was followed by the development of diabetic ketoacidosis. The diagnosis of swallow presyncope was confirmed with a provocative swallow study demonstrating 8 s sinus arrest, and an underlying cause of Candida esophagitis was found by upper endoscopy. Symptoms completely resolved after treatment with micafungin.

Keywords: Candida; Deglutition; Deglutition disorders; Diabetic ketoacidosis; Dysphagia; Esophagitis; Swallow; Syncope.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Antifungal Agents / therapeutic use
  • Candida*
  • Candidiasis / complications*
  • Candidiasis / drug therapy
  • Candidiasis / microbiology
  • Deglutition Disorders / drug therapy
  • Deglutition Disorders / microbiology*
  • Diabetic Ketoacidosis / drug therapy
  • Diabetic Ketoacidosis / microbiology
  • Esophagitis / complications*
  • Esophagitis / drug therapy
  • Esophagitis / microbiology
  • Female
  • Humans
  • Micafungin / therapeutic use
  • Syncope / drug therapy
  • Syncope / microbiology*

Substances

  • Antifungal Agents
  • Micafungin