A rare case of eosinophilic esophagitis with ulcerative pattern

Abstract

Introduction. Eosinophilic esophagitis (EoE) is a chronic, immune/antigen-mediated esophageal disease, considered to be caused by chronic, late-phase allergic reactions to various allergens, including food and environmental antigens. Case presentation. A 27-year-old woman presented for dysphagia, chest pain, vomiting, weight loss and painful aphtoid lesions in the oral cavity. An upper digestive endoscopy has been performed, that revealed attenuation of the subepithelial vascular pattern, exudate and edema in the cervical esophagus. In the lower thoracic esophagus, numerous ulcerative lesions and extremely fragile mucosa with numerous white papules have been observed. Multiple biopsies have been obtained from the distal esophagus, that showed a high number of eosinophils (>15 eosinophils per high power field). After seven days of treatment with omeprazole, topical glucocorticoids (Fluticasone) and allergen elimination diet, an upper endoscopy was repeated, revealing a significant improvement in the macroscopic aspect of the esophageal mucosa. Eight weeks later, the endoscopic reevaluation showed normal esophageal mucosa, biopsies containing less than 5 eosinophils per high power field. Conclusions. EoE should be suspected in adults with a history of food impaction, with persistent dysphagia for solids, or with gastroesophageal reflux disease that fails to respond to medical therapy. In patients suspected of having EoE, the first diagnostic test is the upper endoscopy with esophageal biopsies. The early diagnosis of EoE in young patients with suspicious symptoms can help prevent further complications, such as fibrotic esophageal strictures or even Boerhaave s syndrome.