Case 1:
Case History and Examination: A 47-year-old male patient presented to the emergency department with difficulty swallowing after eating a piece of steak. He reported several episodes of food getting “stuck” in his esophagus. This dysphagia was not associated with any other alarming signs, including weight loss or fever. Four months prior, he was diagnosed with PV after presenting with painful blisters and erosions all over his body following painful oral erosions. At that time, physical examination revealed flaccid bullae and erosions all over his body (Figure 1a), with no genital or ocular lesions, no lymphadenopathy, and no associated systemic signs. PV was confirmed by a skin biopsy revealing suprabasal epidermal acantholysis and direct immunofluorescence showing intercellular deposits of C3 and IgG in the epidermis. He had been treated with oral prednisone at a dosage of 1 mg/kg/day, which was tapered over 4 weeks, leading to full remission with no relapse on follow-up three months later.
Methods: Differential Diagnosis, Investigations, and TreatmentThe initial differential diagnosis for the patient’s current presentation included esophageal involvement by PV and EoE. An urgent upper endoscopy revealed a meat bolus lodged in the mid-esophagus along with esophageal rings and furrows (Figure 1b). Multiple biopsies were taken to rule out esophageal involvement by PV and EoE. Histology showed 20 eosinophils per high-power field with no signs of PV, confirming a diagnosis of EoE.