Esophagitis dissecans superficialis presenting with massive haematemesis in a patient with bullous pemphigoid

The stratified squamous epithelial lining of the esophagus is similar to that of the skin, and occasionally conditions that affect the skin tend to have esophageal manifestations. Autoimmune dermatological conditions that present with blisters are referred to as bullous dermatoses and have been found to rarely present with esophageal involvement. Esophageal epithelium is thought to be involved in rare occasions because of its identical epithelial lining to the skin and tends to be more frequent among patients with pemphigus vulgaris than in those with pemphigoid. Common symptoms from esophageal involvement in bullous dermatoses may include heartburn, odynophagia or dysphagia. Rarely, it may present with vomiting of sloughed cast of esophageal mucosa or haematemesis. We present S A, a 47 year old female who was on outpatient treatment in 2010 at King Fahad Medical City for bullous pemphigoid but developed progressive odynophagia with massive haematemesis. She was admitted and resuscitated, and endoscopy revealed sloughing of esophageal mucosa and bleeding in keeping with esophagitis dissecans superficialis. Although association of esophageal dissecans superficialis with pemphigus vulgaris has been sparsely reported; to our knowledge its association with bullous pemphigoid as in our case has been rarely reported in English medical literature.