Lymphocytic esophagitis mimicking eosinophilic esophagitis
A 74-year-old male with a history of 3 years duration of dysphagia presented with acute food impaction. The patient had a history of lymphoma and esophagitis with stricture without the symptoms of gastro-esophageal reflux disease (GERD). Following endoscopic removal of the impacted meat he had severe chest pain with evidence of perforation of the esophagus with pneumomediastinum on chest CT scan which resolved uneventfully. A later endoscopy showed a tight distal stricture and course rings at the middle third of the esophagus (). A mucosal split occurred during endoscopy (, black arrow). Biopsies taken from the middle third of the esophagus showed marked infiltration of exclusive intraepithelial lymphocytes in a peripapillary distribution (). There was no eosinophilic component, thus ruling out eosinophilic esophagitis.\nThe immunostains showed presence of CD3 and CD5 lymphocytes (T cell markers) in the epithelium (). The specimen was negative for CD 20 lymphocytes (B cell marker). The esophageal manometry showed diffuse esophageal spasm with partial relaxation of the lower esophageal sphincter. The patient had prior chemotherapy for non-Hodgkin lymphoma present in his nostril and leg. The lymphoma was monoclonal B-cell CD20 positive. Thus, the lymphocytes (CD3 and CD5) present in the esophageal epithelium are distinct from the lymphoma (CD20). Four year follow up with 5 endoscopies shows persistence of the endoscopic and biopsy findings. The patient was dilated each time and received botox twice.