A 57-year-old man who had experienced heartburn and dysphagia for 4 months was referred
for endoscopy. The results of his physical examination were normal, without ocular,
cutaneous, or atopic findings. Endoscopy showed linear furrows and whitish exudates
in the distal esophagus (A) . Esophageal eosinophilic infiltration was confirmed in both the distal (45 eosinophils
per high-power field) and proximal (25 eosinophils per high-power field) esophagus
(A, inset). Consensus recommendations were made, and the patient was treated with rabeprazole
20 mg twice daily for 8 weeks and achieved clinical remission. On follow-up endoscopy
and biopsy, the endoscopic features and esophageal eosinophilia were in remission.
Interestingly, the distal esophagus was involved by several longitudinal white plaque
lesions (B), which had a characteristic fish-scale pattern (C). Histologic examination revealed a prominent granular layer and severe hyperkeratosis
over the squamous epithelium, mimicking the corneal layer of epidermis (D), without dysplasia. Esophageal fungus, viral infections, and nutritional deficiencies
were ruled out. Three months later, the patient remained asymptomatic while receiving
proton pump inhibitor therapy, and the findings persisted on repeat endoscopy.
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Publication history
Lawrence J. Brandt, MD, Associate Editor for Focal Points
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© 2013 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
