S4252 Lichenoid Esophagitis Presentation in a Patient

Introduction: We present diagnosis and management of a patient presenting with dysphagia due to lichenoid esophagitis. Case Description/Methods: A 64-year-old white woman presents with a 10-year history of recurrent esophageal stricture and dysphagia. The patient undergoes repeat esophagogastroduodenoscopy for esophageal dilation and triamcinolone injection. Given recurrent symptoms a biopsy is conducted. The pathology demonstrates severely active neutrophilic esophagitis with ulceration and parakeratosis. There is sloughing of the esophageal mucosa. The patient is advised to continue pantoprazole twice daily and sucralfate daily. The patient continues to have recurrent dysphagia and food impaction over the next year. Repeat biopsies of the proximal and distal esophagus show squamous mucosa with mixed inflammatory infiltrates, involving the lamina propria distally, with lymphocytic predominance and multiple dyskeratotic cells. Due to the presence of dyskeratosis with possible lichen planus another biopsy with immunofluorescence is performed to confirm the diagnosis. The biopsy presents squamous mucosa with brisk chronic inflammation with a lichenoid inflammatory pattern, scattered Civatte bodies, and eosinophils. The presented inflammatory pattern and Civatte bodies indicate esophageal lichen planus. The patient initiates swallowing fluticasone and is referred to dermatology. Overall the patient's symptoms improve over the next year, without the need for endoscopic dilation. The patient is advised to take pantoprazole with fluconazole twice daily, 2 fluticasone puffs twice daily, and to follow up with dermatology. Discussion: Lichenoid esophagitis is a rare diagnosis that presents with dysphagia, esophageal strictures, and Civatte bodies on pathology. The pathophysiology and treatment options should be discussed with affected patients. Treatment options include endoscopic dilation and topical steroids.