Shamimul Hasan, Dhruv Desval, Mambakkam Jayakanth, N. Anoop Kumar
Oral candidiasis is a common opportunistic fungal infection of the oral mucosa predominantly caused by Candida albicans. This condition frequently develops when local or systemic host defense mechanisms are compromised. Several predisposing factors, including poor oral hygiene, xerostomia, immunosuppression, prolonged antibiotic therapy, and the use of inhaled corticosteroid medications, can disrupt the oral microbial balance and promote fungal colonization. Acute pseudomembranous candidiasis (oral thrush) is the most common clinical presentation, and is characterized by scrapable white plaques in the oral mucosa. A 37 year-old female patient presented with a two-month history of a persistent burning sensation in the oral cavity that was aggravated by spicy foods. The patient had a history of bronchial asthma and reported the use of inhaled bronchodilators containing budesonide and formoterol without routine mouth rinsing post-inhalation. Intraoral examination revealed diffuse curd-like white plaques involving the dorsal tongue, palatal mucosa, and buccal mucosa bilaterally. Gentle scraping of the lesions resulted in partial removal of the plaque, exposing the erythematous mucosal surface. Histopathological examination revealed fungal hyphae with neutrophilic microabscesses. Periodic acid-Schiff staining confirmed the presence of Candida species. The patient was treated with systemic fluconazole and topical antifungal therapy, along with reinforcement of oral hygiene practices and counseling on proper inhalation techniques with post-inhalation mouth rinsing. Complete resolution of the lesions was observed within 10 days, with no recurrence at two-month follow-up. This case emphasizes the need for early detection of inhaler-associated oral candidiasis and highlights the critical role of preventive strategies, including proper inhalation techniques and oral hygiene measures, in reducing the risk of fungal colonization and recurrence.