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.