Vibhu Chittajallu, MD1, Michael Cruise, MD1, Malav P. Parikh, MD2; 1Cleveland Clinic Foundation, Cleveland, OH; 2SUNY Downstate Health Sciences University, Brooklyn, NY
Introduction: A healthy 26-year-old African American male presented to the hospital due to recent history of dysphagia, odynophagia and progressive weight loss. Symptoms began two weeks ago with an episode of choking and occurred both, with solids and liquids. There was no history of asthma, food allergies, eczema, or other skin rashes. He admitted to socially smoking tobacco and drinking alcohol but no illicit drugs. Patient was sexually active with males. Physical examination was grossly unremarkable and laboratory tests were negative for leukocytosis, eosinophilia and anemia, however, his HIV testing was positive (CD4 count: 30 cells/mm3). Chest X-ray was unremarkable.
Methods: Patient underwent esophagogastroduodenoscopy (EGD), where a few cratered, punched out non-bleeding esophageal ulcers were noted, 35-37 cm from the incisors along with LA Grade C esophagitis. Esophageal biopsy results are as shown in figure 2. Discussion: Esophageal biopsies for this patient diagnosed him with lichenoid esophagitis pattern (LEP). LEP is diagnosed in patients who have characteristic pathologic findings of lichen planus esophagitis (LPE) without confirmation with direct immunofluorescence (DIF). Epidemiologically, LEP is generally diagnosed in younger patients than LPE with both diagnoses affecting white females primarily. The predominant symptomatology of LEP is dysphagia. Diagnosis is dependent on esophageal biopsies with most common indication for EGD being dysphagia. Endoscopic evaluation of a patient with LEP will demonstrate mucosa that may be acanthotic and/or atrophic in conjunction to esophagitis, ulcerations, and/or strictures with a predilection for involvement of the mid esophagus. Histologic evaluation will note a pattern of injury composed of mostly lymphocytes affecting the epithelium and lamina propria. Civatte bodies, apoptotic squamous cells, can be seen dispersed throughout the epithelium and should be considered as a diagnostic criterion in biopsy evaluation. There is a correlation between viral diseases (HIV, hepatitis B/C) and patients diagnosed with LEP – also depicted in our patient. Management of LEP is primarily steroids and immunomodulators. The primary concerns with diagnosing LEP are for symptom management and surveillance for progression to malignancy. We believe that LEP is a largely underreported disease due to practioners being uninformed in typical presentation in addition to endoscopic/pathologic features and this report may provide some clarification.
Figure-1 (EGD) – Diffuse atrophic mucosa with numerous non-bleeding ulcerations in mid esophagus
Figure-2 (Pathology) – Shows dense basely located lymphocytic infiltrate (panel-A) in addition to apoptotic squamous cells (Civatte bodies), marked by red circles (Panel-B)
Disclosures: Vibhu Chittajallu indicated no relevant financial relationships. Michael Cruise indicated no relevant financial relationships. Malav Parikh indicated no relevant financial relationships.