Reversible esophageal motility disorder in a patient with sarcoidosis

We report the case of a patient who presented with new onset of dysphagia for solids and liquids. Her condition was subsequently diagnosed as sarcoidosis on the basis of granulomatous inflammation in tissue obtained from transbronchial fine needle aspiration, noncaseating granulomas in a full-thickness lip biopsy, mild uveitis on slit lamp examination, and serum angiotensin-converting enzyme activity of 120 U/L. Esophageal manometry revealed a nonspecific esophageal motility disorder with 60% nontransmitted contractions and a lower esophageal sphincter that failed to relax with wet swallows. The patient was treated with 40 mg prednisone per day, and within 2 wk her dysphagia had markedly improved. Prednisone was continued with a slow taper, and after 1 month ber dysphagia had resolved and her esophageal manometry was normal. To our knowledge, this is the first case of sarcoidosis presenting with dysphagia and documented esophageal dysmotility in which symptoms and manometric abnormalities normalized after therapy with systemic corticosteroids.