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Bharat Rao [1; 2] and Abhishek Gulati [1; 2] and Blair Jobe [3; 4] and Shyam Thakkar [1; 2]
Academic Editor: Tetsuo Hirata
1, Department of Gastroenterology, Allegheny Health Network, Pittsburgh, PA, USA, ahn.org
2, Allegheny Center for Digestive Health, 1307 Federal Street, Suite 301, Pittsburgh, PA 15212, USA, ahn.org
3, Department of Surgery, Allegheny Health Network, Pittsburgh, PA, USA, ahn.org
4, Esophageal and Lung Institute, 4815 Liberty Avenue, Mellon Pavilion, Suite 158, Pittsburgh, PA 15224, USA, ahn.org
Received Jun 6, 2017; Revised Aug 20, 2017; Accepted Aug 30, 2017
This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
1. Introduction
Lichen planus (LP), an inflammatory disorder with an unknown etiology, commonly manifests in the oral mucosa and skin [1]. LP though may involve much less common sites including the esophagus [2]. It is not uncommon to take few to several years to correctly diagnose esophageal lichen planus (ELP) due to unfamiliarity with the disease, often nonspecific endoscopic and histopathology findings, and the possibility of ELP being the first manifestation of LP [3, 4]. We present our own experience of a patient with a severe case of ELP in order to further the understanding of this potentially chronic and debilitating stricturing disease. Important concepts to diagnosis ELP early in its course along with management strategies are reviewed.
2. Case Presentation
A 67-year-old woman presented with a long-standing history of dysphagia and recurrent strictures. She did not have typical heartburn or regurgitation symptoms consistent with reflux disease. Her medical history included psoriasis and hypothyroidism. Exam findings of oral lesions or skin findings consistent with LP were not identified.
Laboratory investigations were remarkable for a positive antinuclear antibody with titres of 1 : 320 in a homogenous pattern with other autoimmune markers being nonreactive. Hepatitis C antibody was also nonreactive. Histopathology specimens predominantly showed nonspecific findings of acute and chronic inflammation suggestive of reflux disease.
She underwent multiple esophagogastroduodenoscopies (EGD) with findings of mucosal friability, webs, and strictures (Figures 1–3). Initial examinations revealed strictures in the lower third of the esophagus. Later, strictures were discovered in both the proximal and mid-esophagus. Strictures ranged in diameter within 9–14 mm.