A 28-year-old man was admitted to our hospital due to intermittent
dysphagia and repetitive episodes of food impaction. No relevant previous
clinical history was referred. Physical examination was within normal
limits.
Gastroscopy was performed and showed several ulcers in the distal
esophagus. The procedure was poorly tolerated and the patient suffered a
Mallory–Weiss tear, which required endoscopic sclerosis. Immediately
after endoscopy, the patient complained of chest pain. A computed tomography
thoracic scan revealed a perforation ([Fig. 1]),
which was managed conservatively with satisfactory clinical outcome.
Fig. 1 Computed tomography
thoracic scan: periesophageal gas collection, indicative of esophageal
perforation.
After 3 months of lansoprazole treatment, a second gastroscopy was
indicated due to persistent dysphagia. Endoscopy demonstrated a corrugated
esophagus ([Fig. 2]) and the presence of a
supracardial fragile mucosa with erosions.
Fig. 2 Endoscopy demonstrated
multiple concentric rings along the esophagus (”corrugated
esophagus“).
During the biopsy procedure a perforation orifice could be seen ([Fig. 3]).
Fig. 3 Endoscopy demonstrated a
perforation orifice in the distal esophagus during the biopsy procedure.
The patient was hospitalized and did well under conservative
treatment.
Pathological examination showed a massive eosinophilic infiltration
of the esophageal mucosa consistent with the diagnosis of eosinophilic
esophagitis ([Fig. 4]).
Fig. 4 Histopathology showed a
massive eosinophilic infiltration of the esophageal mucosa.
Allergologic studies were positive for dog and cat epithelium.
Treatment with topical budesonide and exposure avoidance were indicated. After
follow-up of 1 year, the patient remains asymptomatic.
Eosinophilic esophagitis is a chronic disease characterized by an
eosinophilic infiltration of the esophageal mucosa (> 15
eosinophils/high-power field), the diagnosis of which has increased during the
past few years. The predominant symptoms are dysphagia and food bolus impaction
episodes in adults, and its main complication is esophageal lumen stenosis
[1].
Increasing evidence supports the relevance of an inflammatory
process of immunoallergic etiology in eosinophilic esophagitis pathogenesis
[2]. Inflammation causes structural changes that lead to
a fragile esophageal wall, which increases the perforation risk in the context
of diagnostic and therapeutic procedures [3]
[4]
[5].
Therefore, eosinophilic esophagitis must be included in the
differential diagnosis of dysphagia. As biopsy samples are essential for
diagnosis, special care has to be taken when obtaining these samples, in order
to minimize the risk of severe complications such as esophageal
perforation.
Endoscopy_UCTN_Code_CPL_1AH_2AB
Endoscopy_UCTN_Code_CPL_1AH_2AF
