George Washington University School of Medicine and Health Sciences Washington, DC, United States
Julia L. Boland, MD1, Kasra Adham, MD2, Dhvani Shah, MD3, Lysandra Voltaggio, MD4 1George Washington University School of Medicine and Health Sciences, Washington, DC; 2Johns Hopkins Sibley Memorial Hospital, Chevy Chase, MD; 3Johns Hopkins Sibley Memorial Hospital, Washington, DC; 4Johns Hopkins University Hospital, Baltimore, MD
Introduction: Lichenoid esophagitis is a rare pathologic diagnosis, marked by a lichenoid pattern of inflammation in the esophagus without features of lichenoid planus. We present a case of a young male who presented with chronic progressive intermittent dysphagia and was found to have lichenoid esophagitis on esophageal biopsies.
Case Description/Methods: A 27 year old male with a history of asthma and nasal polyps presented with complaints of progressive intermittent dysphagia to solids for the past 5 years. He describes solid food dysphagia three times over the past year. The episodes previously resolved with drinking water. He denied a history of gastroesophageal reflux, nausea, emesis, gastrointestinal bleeding or prior food impaction. His family history was significant for a mother, grandfather, sister and aunt with celiac disease. Comprehensive metabolic panel was normal. Celiac disease panel was negative. His medications included dupilumab, budesonide, formoterol, and albuterol for asthma. He denied drug or tobacco use, and reported social alcohol use. Esophagogastroduodenoscopy revealed diffuse, continuous concentric rings of mucosa without bleeding in the whole esophagus and grade 1 esophagitis in the distal esophagus. There was no evidence of furrowing, exudates, or findings suggestive of eosinophilic esophagitis. A 48F Savary dilation was performed with resolution of dysphagia. Biopsies were performed at the lower third and upper third of the esophagus and showed lichenoid esophagitis (Figure 1).
Discussion: Histopathology of lichenoid esophagitis shows apoptotic keratinocytes (civatte bodies) and intraepithelial lymphocytosis. A lichenoid esophagitis pattern may be seen in association with lichen planus, polypharmacy, rheumatologic diseases, and viral infections, including hepatitis and HIV. There is a low but documented risk of progression to malignancy. The majority of patients who present with lichenoid esophagitis pattern or lichenoid planus esophagitis are female. There was no history of lichen planus or skin involvement in our male patient. Studies have shown that polypharmacy ( >3 medications) and the use of immunomodulatory agents is common among patients with lichenoid esophagitis. Our patient took multiple asthma medications including dupilumab, which may have contributed to his presentation. With scant available literature, lichenoid esophagitis is a rare yet significant etiology of dysphagia due to its malignancy risk.
Figure: Figure 1: histopathology showing a basal-predominant, lymphocyte-rich, lichenoid inflammatory infiltrate with associated dyskeratosis (apoptotic squamous cell, top left).
Julia Boland indicated no relevant financial relationships.
Kasra Adham indicated no relevant financial relationships.
Dhvani Shah indicated no relevant financial relationships.
Lysandra Voltaggio indicated no relevant financial relationships.
Julia L. Boland, MD1, Kasra Adham, MD2, Dhvani Shah, MD3, Lysandra Voltaggio, MD4. P2426 - Lichenoid Esophagitis: An Atypical Etiology of Dysphagia in a Young Male, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.