The Diagnosis of Esophageal Lichen Planus: Recurrent Esophageal Strictures, Delayed-Onset Rash, and Tracheal Stenosis

Lichen planus (LP) is a chronic inflammatory disorder involving the skin and mucous membranes. Esophageal LP is often under-recognized and may present with or without other mucocutaneous sites of involvement. Its diagnosis is made challenging by its variable presentation and high rate of negative biopsies. Although some studies have suggested diagnostic criteria and severity grading, no formal guidelines exist. Diagnosis is made with a combination of clinical presentation, macroscopic findings on endoscopy, and histologic evidence. This case report highlights the challenges in the diagnosis of biopsy-negative esophageal LP and importance of timely diagnosis and initiation of appropriate medical therapy.