Lymphocytic Esophagitis Mimicking Eosinophilic Esophagitis and Esophageal Candidiasis: A Case Report.
This case illustrates the diagnostic complexity of esophageal conditions and the challenges in achieving symptom relief despite treatment.
Where it sits
this study against the rest of the mgf (mechano growth factor) corpusSummary and findings
A 59-year-old man with a 5-year history of progressive dysphagia underwent esophagogastroduodenoscopy (EGD), which revealed an esophageal stricture and fungal elements in biopsy specimens. The diagnosis of lymphocytic esophagitis was made based on marked intraepithelial lymphocytic infiltration and predominance of CD3-positive T cells. Symptoms persisted despite treatment with various medications.
Abstract
A 59-year-old man presented with a 5-year history of progressive dysphagia. Esophagogastroduodenoscopy (EGD) revealed an esophageal stricture with adherent whitish exudates, and biopsy specimens demonstrated fungal elements. Subsequent EGD showed longitudinal furrows, concentric rings, and white exudates, mimicking eosinophilic esophagitis. Biopsy specimens revealed marked intraepithelial lymphocytic infiltration without eosinophils. Immunohistochemistry demonstrated a predominance of CD3-positive T cells, leading to a diagnosis of lymphocytic esophagitis. Despite treatment with proton pump inhibitors, H2-receptor antagonists, antifungal agents, and inhaled fluticasone, his symptoms persisted without sustained improvement.
Background
This case report addresses the clinical challenge of differentiating lymphocytic esophagitis from eosinophilic esophagitis and esophageal candidiasis. Prior knowledge indicated that eosinophilic esophagitis is characterized by eosinophilic infiltration, while lymphocytic esophagitis features lymphocytic infiltration. Understanding these distinctions is crucial for appropriate diagnosis and management.
Methods
The study describes a single case of a 59-year-old male patient with a history of dysphagia. Esophagogastroduodenoscopy (EGD) was performed to evaluate the esophagus, and biopsy specimens were analyzed for histopathological findings. The treatment regimen included proton pump inhibitors, H2-receptor antagonists, antifungal agents, and inhaled fluticasone.
Results
EGD findings included longitudinal furrows, concentric rings, and white exudates, which mimicked eosinophilic esophagitis. Biopsy results revealed marked intraepithelial lymphocytic infiltration without eosinophils, leading to the diagnosis of lymphocytic esophagitis. Despite treatment, symptoms persisted without sustained improvement.
Interpretation
This case highlights the importance of accurate histopathological diagnosis in esophageal disorders. The predominance of CD3-positive T cells suggests a distinct inflammatory process compared to eosinophilic esophagitis. The lack of sustained improvement despite treatment raises questions about the effectiveness of current therapeutic approaches for lymphocytic esophagitis.
Key findings
- 5-year history of progressive dysphagia reported.
- EGD revealed esophageal stricture with adherent whitish exudates.
- Biopsy specimens demonstrated marked intraepithelial lymphocytic infiltration without eosinophils.
- Immunohistochemistry showed predominance of CD3-positive T cells.
Limitations
- Single case report limits generalizability.
- No quantitative data on treatment outcomes provided.
- Lack of long-term follow-up data.