Esophageal lichen planus: An unusual cause of dysphagia in the elderly

Abstract

An 82-year-old man sought our service with dysphagia and was referred for upper endoscopy with biopsies, which evidenced multiple ulcers of the esophagus and oropharinx. Histopathology confirmed the unusual diagnosis of esophageal lichen planus. The correct clinical suspicion of this disease can facilitate the diagnosis and guide specific treatment, which can drastically change the natural course of the disease.Keywords: Deglutition Disorders. Lichen Planus. Aged. case reportAn 82-year-old man sought our service with oropharyngeal and esophageal dysphagia for solid foods for the preceding three months. He had a previous history of hypertension, diabetes and coronary angioplasty. Differential diagnoses were suspected, such as tumors, Zenker diverticulum, extrinsic structural lesions, cervical spondylosis, strictures, reflux and eosinophilic esophagitis. The patient was referred for upper endoscopy, which showed multiple ulcers and friable mucosa involving the upper esophagus and oropharynx, without changes in the distal esophagus, gastroesophageal junction, stomach and duodenum (Figure 1). Esophageal biopsies were obtained for histopathology, which revealed squamous epithelial hyperplasia with chronic T-cell lymphocytic infiltrate (CD4, CD8 positive) with interface aggression, apoptotic basal, covered by fibrinous exudate. There was no immunohistochemical evidence of viral or fungal infection. Due to this findings, the diagnosis of esophageal lichen planus (Figures 2 and 3) was confirmed. The patient was referred for specific treatment and remains asymptomatic at follow-up. discussionLichen planus (LP) is an idiopathic disorder, affecting 0.5% to 2% of the population, with clinical manifestation in the skin, nails, hair, genital and mucosal surface.

Lichen planus: Five variants presenting in one patient

“…Fewer than 100 cases of ELP occur in the literature; however, it may be underreported 4 . Histologic features of ELP include lichenoid inflammation and Civatte bodies.…”