Esophagitis Dissecans Superficialis (EDS) Secondary to Hair Dye Ingestion: Case Report and Literature Review

Abstract

Esophagitis dissecans superficialis (EDS) is a rare and underdiagnosed esophageal lesion characterized by sloughing of the esophageal mucosa that has been associated with medications, various autoimmune disorders, and exposure to some chemical irritants. Anatomically, EDS is most commonly seen in the middle and distal thirds of the esophagus. When present, EDS is best treated by discontinuing the offending agent and initiating pharmacologic therapy with proton pump inhibitors. Steroids may also be effective if the etiology is autoimmune in nature. Our case highlights a 65-year-old female diagnosed with EDS after incidental ingestion of hair dye containing resorcinol and para-phenylenediamine (PPD).

Esofagitis disecante superficial: entidad subdiagnosticada en pacientes pluripatológicos

“…(9,10) En el presente caso, se describe en la endoscopía mucosa esofágica en tercio distal de aspecto "acartonado" asociado a sangrado que se autolimita, características compatibles con lo descrito en otros estudios donde se evidencia que el compromiso más frecuente ocurre en el tercio distal (4) y presenta "hojas" de mucosa parcialmente desprendida o mucosa arrugada. (2,11) Así mismo, en el caso se presenta esfacelación de mucosa, también característica de EDS, la cual la reportan como desprendimiento de mucosa en tiras verticales, con forma de "cinta de papel de regalo" o en parches. (11,12) Otras manifestaciones pueden ser exudados blanquecinos o erosiones en tercio medio o distal.…”

“…(2,11) Así mismo, en el caso se presenta esfacelación de mucosa, también característica de EDS, la cual la reportan como desprendimiento de mucosa en tiras verticales, con forma de "cinta de papel de regalo" o en parches. (11,12) Otras manifestaciones pueden ser exudados blanquecinos o erosiones en tercio medio o distal.…”

Upper Gastrointestinal Endoscopy for Screening or Surveillance: Complication Avoidance and a Closer Look at the Esophagus

“…Sloughing esophagitis is characterized by superficial necrotic squamous epithelium and endoscopic plaques or membranes (Figure 3) [29]. The symptoms include dysphagia, odynophagia, nausea, vomiting, abdominal pain, heartburn, chest pain, hematemesis, and obstructive symptoms secondary to the accumulation of casts in the esophageal lumen [30]. The pathogenesis is thought to involve exposure to drugs that cause esophageal damage or autoimmune conditions accompanied by esophageal damage.…”

“…Such drugs include dabigatran, nonsteroidal anti-inflammatory drugs, bisphosphonates, and iron. The autoimmune conditions include celiac disease, pemphigus vulgaris, bullous pemphigoid, and lupus [30]. Prognosis is usually favorable, and long-term complications are rare.…”

“…Treatment includes discontinuation of the offending agent and administration of protonpump inhibitors (PPIs). Steroids may be helpful when a patient has an autoimmune condition [30].…”