Association of Eosinophilic Esophagitis and Type 1 Diabetes: A Case Report

Association of Type 1 Diabetes Mellitus and Eosinophilic Esophagitis Introduction Eosinophilic esophagitis (EoE) is a rare chronic immune-mediated disorder characterized by eosinophilic infiltration of the esophageal mucosa. We report the case of a child with type 1 diabetes mellitus (T1DM) who presented with dysphagia and was subsequently diagnosed with EoE. Case Report An 11-year-old boy with a 6-year history of well-controlled type 1 diabetes mellitus on insulin therapy and known celiac disease managed with a gluten-free diet was admitted for progressive dysphagia. Symptoms initially involved solid foods and subsequently progressed to both solids and liquids over a one-month period. Physical examination revealed mild growth retardation (−1.5 SD) and conjunctival pallor. Upper gastrointestinal endoscopy demonstrated ulcerative esophagitis extending over 5 cm. Histopathological examination of esophageal biopsies confirmed eosinophilic esophagitis. Duodenal biopsies showed subtotal villous atrophy consistent with celiac disease. The patient was treated with proton pump inhibitors (PPIs) and topical corticosteroid therapy. Due to the unavailability of commercially prepared topical budesonide formulations (oral viscous suspension or spray), an alternative preparation combining injectable budesonide with stevia was administered. A marked clinical improvement was observed within 48 hours. Discussion The coexistence of eosinophilic esophagitis and type1 diabetes mellitus is uncommon. Previous studies have reported a predominance among male patients. Diagnosis relies on upper gastrointestinal endoscopy with systematic esophageal biopsies. The current standard treatment consists of proton pump inhibitors combined with topical corticosteroids. Conclusion Eosinophilic esophagitis remains a rare condition with incompletely understood pathogenesis and natural history. It may present with a wide spectrum of gastrointestinal symptoms and has been associated with connective tissue disorders and several autoimmune diseases. However, its association with type 1 diabetes mellitus remains exceptionally rare.