Ulcerative Esophagitis With Marked Eosinophilic Infiltration and Fluorodeoxyglucose-Positron Emission Tomography Positivity Requiring Differentiation From Esophagogastric Junction Carcinoma.
Eosinophilic esophagitis can present with ulceration and stricture, requiring careful differentiation from esophageal cancer. Mucosal healing can occur with appropriate treatment, including proton pump inhibitors.
Where it sits
this study against the rest of the igf-1 lr3 (long r3 igf-1) corpusSummary and findings
A 50-year-old man with marked eosinophilic infiltration and ulceration of the esophagus underwent multiple diagnostic procedures. Endoscopic biopsies revealed 70 eosinophils per high-power field, meeting the criteria for eosinophilic esophagitis. After treatment, mucosal healing was confirmed following proton pump inhibitor therapy.
Abstract
Esophagitis with marked eosinophilic infiltration, including eosinophilic esophagitis (EoE), can rarely present with ulceration or stricture. We report a rare case of positron emission tomography-positive esophagitis with marked eosinophilic infiltration accompanied by ulceration and stricture, requiring differentiation from esophagogastric junction carcinoma. A 50-year-old man with no history of allergies underwent computed tomography, which revealed para-esophageal lymphadenopathy and circumferential thickening of the distal esophagus. Endoscopy showed an ulcerated stricture with an iodine-unstained area. Positron emission tomography demonstrated fluorodeoxyglucose uptake at the lesion site. Multiple endoscopic biopsies (11 specimens) were negative for malignancy but revealed 70 eosinophils per high-power field, fulfilling the diagnostic criteria for EoE. Hiatal hernia was also observed, suggesting the possibility of concomitant reflux esophagitis. Significant dysphagia persisted due to the severe stricture. Therefore, endoscopic bougie dilation was carefully performed under general anesthesia. After 8 weeks of proton pump inhibitor therapy, mucosal healing was confirmed, and topical steroids were initiated for persistent eosinophilic infiltration. This case highlights that esophagitis with marked eosinophilic infiltration accompanied by ulceration and stricture may require differentiation from cancer.
Background
This paper addresses the clinical challenge of differentiating eosinophilic esophagitis (EoE) from esophagogastric junction carcinoma, particularly in cases presenting with ulceration and stricture. EoE is characterized by eosinophilic infiltration in the esophagus, which can mimic malignancy on imaging studies. Understanding such presentations is crucial for appropriate management and avoiding unnecessary interventions.
Methods
The study reports a case of a 50-year-old male patient with no history of allergies who underwent computed tomography and endoscopy. The patient had circumferential thickening of the distal esophagus and an ulcerated stricture. Multiple endoscopic biopsies were taken, and treatment involved endoscopic bougie dilation and proton pump inhibitors.
Results
The primary endpoint was the eosinophil count, which was 70 eosinophils per high-power field in biopsy specimens. Endoscopic findings included an ulcerated stricture, and positron emission tomography showed fluorodeoxyglucose uptake at the lesion site. After 8 weeks of treatment, mucosal healing was confirmed.
Interpretation
This case adds to the literature on EoE by illustrating its potential to present with significant symptoms that may mimic malignancy. The eosinophil count of 70 per high-power field is indicative of EoE, but the clinical significance of this finding must be interpreted cautiously. The limitations include the lack of a control group and the singular nature of the case, which may not be generalizable.
Key findings
- 70 eosinophils per high-power field in biopsy specimens.
- Endoscopic bougie dilation performed under general anesthesia.
- Mucosal healing confirmed after 8 weeks of proton pump inhibitor therapy.
Limitations
- Single case report limits generalizability.
- No control group for comparison.
- Not reported in abstract.