Esophagitis Dissecans Superficialis: An Uncommon Endoscopic Finding

Esophagitis dissecans superficialis (EDS), also known as sloughing esophagitis, is a rare and frequently underrecognized esophageal disorder characterized by superficial sloughing of the esophageal mucosa. Its variable clinical presentation and overlap with structural esophageal abnormalities may result in misdiagnosis and unnecessary diagnostic or therapeutic interventions. We report a case of a 25-year-old woman with no history of chronic degenerative, autoimmune, or atopic disease who presented with abrupt retrosternal chest pain, recurrent vomiting, progressive esophageal dysphagia, halitosis, hematemesis, and marked unintentional weight loss. Initial evaluation showed a double-lumen appearance on barium esophagography and an upper endoscopic appearance initially interpreted as a large pharyngoesophageal diverticulum. Repeat endoscopy subsequently revealed extensive longitudinal sloughing and detachment of the esophageal mucosa, supporting the diagnosis of EDS. Histopathologic evaluation demonstrated a submucosal blistering lesion infiltrated by eosinophils, without evidence of malignancy or dysplasia. These findings raised suspicion for esophageal bullous pemphigoid; however, direct immunofluorescence was unavailable, and an autoimmune bullous disorder could not be definitively confirmed. Additional computed tomography imaging showed no evidence of esophageal disruption, mediastinal collection, pneumomediastinum, malignancy, or another structural abnormality. Severe oral intolerance, recurrent vomiting, persistent dysphagia, and marked nutritional compromise led the nutrition support team to select temporary total parenteral nutrition as an individualized strategy pending clinical and endoscopic reassessment. The severe mucosal involvement and suspected autoimmune bullous component prompted empiric treatment with intravenous corticosteroids. The patient achieved clinical stabilization, and outpatient endoscopic reassessment was scheduled. In the absence of follow-up endoscopic findings, no conclusions regarding mucosal healing or treatment efficacy could be drawn. This case highlights the importance of careful clinical, endoscopic, radiologic, and histopathologic correlation in severe or atypical presentations of EDS, particularly when the findings mimic a structural esophageal disorder.