Eosinophilic esophagitis as paraneoplastic syndrome in a patient with ganglioneuroblastoma

Area of Science:

• Pediatric Gastroenterology
• Pediatric Oncology
• Clinical Medicine

Background:

• Eosinophilic esophagitis (EoE) is an immune-mediated esophageal disease.
• Paraneoplastic syndromes can manifest with diverse symptoms, including gastrointestinal issues.
• Ganglioneuroblastoma is a rare tumor typically affecting the sympathetic nervous system.

Observation:

• A 16-month-old boy presented with failure to thrive, hypersalivation, abdominal pain, chronic diarrhea, and blepharitis.
• Initial diagnosis of eosinophilic esophagitis (EoE) did not improve with standard treatments.
• Further investigation revealed an intrathoracic, paraspinal ganglioneuroblastoma.

Findings:

• Surgical resection of the ganglioneuroblastoma led to the complete resolution of all presenting symptoms.
• Esophageal biopsies confirmed the absence of eosinophilic esophagitis post-tumor removal.
• This case represents the first reported instance of EoE as a paraneoplastic syndrome associated with a non-carcinomatous malignancy.

Implications:

• Suggests a potential paraneoplastic etiology for eosinophilic esophagitis in pediatric cases, particularly with non-carcinomatous tumors.
• Highlights the importance of a comprehensive diagnostic work-up for refractory pediatric gastrointestinal symptoms.
• Underscores the need to consider rare tumors in the differential diagnosis of complex pediatric presentations.