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LICHEN PLANUS WITH ESOPHAGEAL INVOLVEMENT: A CASE REPORT AND REVIEW OF THE LITERATURE
M Chaklader, J McGrath,
Division of Gastroenterology, Department of Medicine, Memorial University of Newfoundland, St John’s, NL
Lichen planus (LP) is an uncommon disorder of unknown etiology mostly affecting patients in their 5th and 6th decade. It is thought to be an autoimmune process involving the T cells against basal keratinocytes. It mostly affects skin, nails, mucous membranes (especially oral pharynx), vulva and penis. Esophageal involvement is quite rare and can cause strictures, ulcerations and squamous cell cancer.
A 54 yr woman with oral lichen planus was referred for assessment of dysphagia. Initially, dysphagia occurred with solid foods and then progressed to soft foods but sparing liquids. She had lost 20lbs. She did not complain of epigastric pain or reflux symptoms. She has no other significant past medical history. She drinks socially and is a non- smoker.
An esophagogastroduodenoscopy (EGD) was performed and she was diagnosed with pill esophagitis. At the same time, she was also diagnosed with lichen planus in her oral pharynx with no involvement of the esophagus. She was treated with a PPI and her GI symptoms resolved. However, the symptoms returned after a year and a repeat EGD revealed white plaques in the esophagus and the biopsy showed dense lichenoid inflammatory infiltrate underneath the lamina propria. She was subsequently treated with dilatations and intermittent glucocorticoids.
Diagnosis of LP of the esophagus is crucial for the proper treatment. Symptomatic patients should have EGD and biopsies taken. Some of these patients may require systemic immunosuppression as well as mechanical treatment to prevent weight loss and dehydration. Surveillance endoscopies should be carried out to monitor for the development of squamous cell carcinoma.