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Mentions: Esophagogastroduodenoscopy showed some linear furrows and multiple mucosal nodularities on the lower and mid esophagus without reflux esophagitis (Fig. 1), and we took 3 specimens at the lower and mid esophagus, respectively, under suspecting EoE. We also performed multiple biopsies at the stomach and bulb of the duodenum. Whereas multiple mucosal biopsies on the stomach and duodenum were normal, heavy eosinophilic infiltration was observed on the esophageal mucosa (Fig. 2). Based on the clinical, endoscopic and histological findings, the patient was diagnosed as EoE. We found out he had eaten the food (protein complex; Myoplex®, Abbott Laboratories, Abbott Park, Illinios, USA) for 2 months while he built his body. Allergic evaluations for identifying causative allergens were performed by consulting with the specialist of the allergic department. Multiple allergen simultaneous tests showed a hypersensitivity to peanut. Also, we confirmed a hypersensitivity to the protein complex (Myoplex®) by intradermal injection test (Fig. 3). We first started treatment with proton pump inhibitors after endoscopic examination, but the symptoms were improved partially after 2 weeks. After we confirmed the result of biopsies, withholding treatment was added. The patient's symptoms were improved gradually since the withholding treatment. Two months later, follow-up endoscopy revealed a disappearance of linear furrows and mucosal irregularities, and mucosal biopsies showed marked decrease in eosinophil counts less than 5 eosinophils per high power field. The patient was stable without recurrence at the 1 year follow-up.
A Case of Eosinophilic Esophagitis With Food Hypersensitivity
Bottom Line: He had taken a protein complex for 2 months.The skin testing for the protein complex was positive.The patient was successfully treated with withholding treatment.
Affiliation: Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Eosinophilic esophagitis (EoE) is a disorder characterized by isolated eosinophilic infiltration of the esophagus with esophageal symptoms. Although some patients with EoE are related to food hypersensitivity, it is hard to identify causative foods. This report describes a case of EoE with dysphagia. A 28-year-old man presented with dysphagia and substernal discomfort for 15 days. He had taken a protein complex for 2 months. Endoscopy showed several linear furrows and multiple mucosal nodularities on the lower and mid esophagus, and the biopsies of esophagus revealed marked eosinophil infiltration in the mucosa. The skin testing for the protein complex was positive. The patient was successfully treated with withholding treatment.