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- W2912083045 abstract "Background: Eosinophilic esophagitis (EoE) is a clinicopathologic disease characterized by dense eosinophilic infiltration of the esophageal mucosa. Patients usually present with long standing dysphagia or food impaction. Mucosal tears or perforation can occur as rare complications of endoscopic dilation. Spontaneous tears are an uncommon initial manifestation of EoE. Case: A 22 year old male presented with sudden onset severe midsternal chest pain, without emesis, shortly after a meal. Prior history included intermittent dysphagia to solid foods in the preceding year. Upon arrival he was afebrile, normotensive but tachycardic with chest computed tomography scan with contrast showing pan-esophageal thickening with small bilateral pleural effusions. Barium swallow showed features of thickened distal esophagus, without strictures or perforation. Esophagogastroduodenoscopy (EGD) was performed which showed a large, cratered ulcer, 30cm from the incisors in the distal esophagus. Also pallor, linear furrowing and felinization of the mucosa was seen, with proximal and distal biopsies showing 45 and 30 eosinophils per high power field (EPHPF) respectively. The clinical presentation along with endoscopic findings were concerning for a contained esophageal perforation. Patient improved with conservative management of nil oral intake and antibiotics, and was discharged a week later with pantoprazole 40mg twice daily. On EGD evaluation 2 months later, the prior ulcer had resolved. The changes of circular rings and linear furrows remained and repeat proximal and distal esophageal biopsies showed >50 EPHPF respectively. A diagnosis of eosinophilic esophagitis (EoE) was made and the patient was initiated on fluticasone therapy.Figure: Barium swallow image showing ulceration in distal esophagus.Figure: Esophagogastroduodenoscopy image showing deep esophageal ulceration.Discussion: Our patient exemplifies a rare manifestation of EoE, that can be associated with significant morbidity. Increased fragility of the esophageal mucosa from eosinophilic infiltration and subsequent remodeling alters wall compliance and can predispose to mucosal tears. While tears can occur in 0.3% of cases after endoscopic dilation, spontaneous tears are uncommon and sparsely reported. Non-surgical management leads to improvement in 50% of patients. Increased awareness of this rare but serious complication can lead to earlier diagnosis and timely intervention. Also, an evaluation of the factors that may predict early tears or perforation in EoE, is essential to minimize the incidence of this serious complication.Figure: Repeat esophagogastroduodenoscopy showing resolution of prior ulceration." @default.
- W2912083045 created "2019-02-21" @default.
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- W2912083045 date "2017-10-01" @default.
- W2912083045 modified "2023-09-26" @default.
- W2912083045 title "An Uncommon Initial Manifestation of Eosinophilic Esophagitis: Spontaneous Esophageal Tear" @default.
- W2912083045 doi "https://doi.org/10.14309/00000434-201710001-01731" @default.
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