Lymphocytic esophagitis mimicking eosinophilic esophagitis

Area of Science:

• Gastroenterology
• Histopathology
• Immunology

Background:

• Dysphagia is a common symptom requiring investigation.
• Esophageal strictures and rings can cause significant patient morbidity.
• Histologic evaluation is crucial for diagnosing esophageal inflammatory conditions.

Observation:

• A 74-year-old male presented with acute food impaction and a history of dysphagia.
• Endoscopy revealed a distal esophageal stricture with prominent rings.
• Biopsies showed significant intraepithelial T-lymphocyte infiltration, primarily in a peripapillary distribution.

Findings:

• The condition, termed lymphocytic esophagitis, is defined by marked esophageal lymphocytosis.
• Immunostains confirmed the presence of CD3 and CD5 T-cells within the esophageal epithelium.
• This histologic phenotype mimics eosinophilic esophagitis, presenting with similar clinical symptoms.

Implications:

• Lymphocytic esophagitis represents a distinct histologic phenotype of esophagitis.
• Accurate diagnosis relies on identifying esophageal lymphocytosis and T-cell markers.
• Distinguishing lymphocytic esophagitis from eosinophilic esophagitis is critical for appropriate patient management.