Lichenoid esophagitis presenting as fatal upper gastrointestinal bleeding in a 52 year-old woman: a case diagnosed by autopsy
Abstract 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 esopha...
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| Format: | Article |
| Language: | English |
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BMC
2017-08-01
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| Series: | BMC Gastroenterology |
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| Online Access: | http://link.springer.com/article/10.1186/s12876-017-0647-0 |
| _version_ | 1819229100305285120 |
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| author | Andrew Mitchell Tony Petrella |
| author_facet | Andrew Mitchell Tony Petrella |
| author_sort | Andrew Mitchell |
| collection | DOAJ |
| description | Abstract 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 presentation A 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. Conclusions Lichenoid 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. |
| first_indexed | 2024-12-23T11:07:48Z |
| format | Article |
| id | doaj.art-3a5faee330aa44439a2d37e59352958f |
| institution | Directory Open Access Journal |
| issn | 1471-230X |
| language | English |
| last_indexed | 2024-12-23T11:07:48Z |
| publishDate | 2017-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Gastroenterology |
| spelling | doaj.art-3a5faee330aa44439a2d37e59352958f2022-12-21T17:49:26ZengBMCBMC Gastroenterology1471-230X2017-08-011711410.1186/s12876-017-0647-0Lichenoid esophagitis presenting as fatal upper gastrointestinal bleeding in a 52 year-old woman: a case diagnosed by autopsyAndrew Mitchell0Tony Petrella1Department of Anatomical Pathology and Cytology, Maisonneuve-Rosemont HospitalDepartment of Anatomical Pathology and Cytology, Maisonneuve-Rosemont HospitalAbstract 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 presentation A 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. Conclusions Lichenoid 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.http://link.springer.com/article/10.1186/s12876-017-0647-0LichenoidEsophagitisLichen planusAutopsyCase report |
| spellingShingle | Andrew Mitchell Tony Petrella Lichenoid esophagitis presenting as fatal upper gastrointestinal bleeding in a 52 year-old woman: a case diagnosed by autopsy BMC Gastroenterology Lichenoid Esophagitis Lichen planus Autopsy Case report |
| title | Lichenoid esophagitis presenting as fatal upper gastrointestinal bleeding in a 52 year-old woman: a case diagnosed by autopsy |
| title_full | Lichenoid esophagitis presenting as fatal upper gastrointestinal bleeding in a 52 year-old woman: a case diagnosed by autopsy |
| title_fullStr | Lichenoid esophagitis presenting as fatal upper gastrointestinal bleeding in a 52 year-old woman: a case diagnosed by autopsy |
| title_full_unstemmed | Lichenoid esophagitis presenting as fatal upper gastrointestinal bleeding in a 52 year-old woman: a case diagnosed by autopsy |
| title_short | Lichenoid esophagitis presenting as fatal upper gastrointestinal bleeding in a 52 year-old woman: a case diagnosed by autopsy |
| title_sort | lichenoid esophagitis presenting as fatal upper gastrointestinal bleeding in a 52 year old woman a case diagnosed by autopsy |
| topic | Lichenoid Esophagitis Lichen planus Autopsy Case report |
| url | http://link.springer.com/article/10.1186/s12876-017-0647-0 |
| work_keys_str_mv | AT andrewmitchell lichenoidesophagitispresentingasfataluppergastrointestinalbleedingina52yearoldwomanacasediagnosedbyautopsy AT tonypetrella lichenoidesophagitispresentingasfataluppergastrointestinalbleedingina52yearoldwomanacasediagnosedbyautopsy |