Lichenoid esophagitis presenting as fatal upper gastrointestinal bleeding in a 52 year-old woman: a case diagnosed by autopsy

BMC Gastroenterology

Case Report

Tony Petrella¹  Andrew Mitchell¹ 

[1] Department of Anatomical Pathology and Cytology, Maisonneuve-Rosemont Hospital, 5415 Boulevard de L’Assomption, H1T 2M4, Montreal, Quebec, Canada;

关键词: Lichenoid;    Esophagitis;    Lichen planus;    Autopsy;    Case report;   

DOI  :  10.1186/s12876-017-0647-0

 received in 2016-12-20, accepted in 2017-07-16,  发布年份 2017

来源: Springer

【 摘 要 】

Background“Lichenoid esophagitis” is a descriptive term for a lichenoid pattern of inflammation in the esophagus for which a precise histologic diagnosis cannot be established. The differential diagnosis includes lichen planus, a drug-related reaction, and viral infection. Lichenoid esophagitis causing death has not been reported previously. We describe a case, diagnosed by autopsy, of lichenoid esophagitis in which massive bleeding from generalized epithelial sloughing and a large longitudinal ulcer proved fatal.Case presentationA 52 year-old diabetic woman collapsed at her home in front of an acquaintance. “Bloody vomit” was noted. Despite resuscitation efforts, the patient died. A complete autopsy was performed. The middle portion of the esophagus showed a 9 cm longitudinal ulcer situated 12 cm from the esophago-gastric junction. Microscopic examination showed complete sloughing of the esophageal epithelium with a striking subepithelial lichenoid lymphocytic infiltrate extending into the muscularis mucosae. The findings were considered compatible with lichenoid esophagitis. Laboratory studies also showed the presence of diabetic ketoacidosis.ConclusionsLichenoid esophagitis is an appropriate diagnostic term when clinical, histologic and laboratory findings do not allow for specific categorization of lichenoid inflammation in the esophagus. As illustrated here for the first time, lichenoid esophagitis may cause ulceration and mucosal sloughing severe enough to result in massive upper gastrointestinal bleeding and death. Translating these autopsy findings to the clinical setting, it is possible that the endoscopic finding of a longitudinal mid-esophageal ulcer in the presence of proximal stricture may be indicative of underlying lichenoid esophagitis.

【 授权许可】

CC BY   
© The Author(s). 2017