Eosinophilic esophagitis presenting with spontaneous esophageal rupture: a case report

Abstract

Background Eosinophilic esophagitis, once considered a rare disorder, has been increasingly recognized as a leading cause of dysphagia and food impaction in children and adults over the last few decades. It predominantly occurs in young men with a history of atopy. Dysphagia and food impaction are the most common presentations. However, rarely, spontaneous perforation (Boerhaave’s syndrome) may occur in association with eosinophilic esophagitis. Case presentation A 40-year-old white woman with known history of eosinophilic esophagitis, who was non-compliant with treatment, presented with chest pain and developed acute spontaneous transmural esophageal perforation while eating a snack. Surgical repair was required. Conclusion In a relatively young patient who presents with spontaneous esophageal perforation, eosinophilic esophagitis should always be ruled out as subsequent treatment may prevent recurrent perforation.

Eosinophilic Esophagitis in the Setting of Prior Caustic Ingestion

“…EoE, once considered a rare entity, is now one of the most common conditions diagnosed during the evaluation of dysphagia and food impaction in children and adults [ 4 ]. There has been a significant increase in the prevalence of EoE, which is associated with an increase in its incidence as well as an improvement in diagnostic methods.…”

Eosinophilic Esophagitis After an Allegra-D Bolus: A Case Report

“…Typically, the highest numbers are found in the cecum and appendix, whereas the squamous epithelium of the esophagus is normally devoid of eosinophils [ 5 ]. The accepted qualification for EoE diagnosis is currently an intraepithelial eosinophil count of 15 or more eosinophils per HPF from esophageal biopsies [ 1 , 2 ]. Our patient was reported to have up to 30 eosinophils per HPF from the proximal esophageal biopsy, which satisfies the requirements for an EoE diagnosis.…”

“…Eosinophilic esophagitis (EoE) is an immune-mediated disorder commonly occurring in adults aged 35 to 45 years or in children aged 5.4 to 9.6 years [ 1 ]. The disease is known to cause gastrointestinal symptoms such as dysphagia, reflux, nausea, vomiting, abdominal pain, or food impaction as a result of eosinophilic infiltration of the esophagus [ 2 , 3 ].…”

“…The disease is known to cause gastrointestinal symptoms such as dysphagia, reflux, nausea, vomiting, abdominal pain, or food impaction as a result of eosinophilic infiltration of the esophagus [ 2 , 3 ]. The prevalence of food impaction secondary to EoE has significantly risen over time especially in the male Caucasian population [ 1 , 2 ].…”

“…Co-occurring allergic or atopic diseases including atopic dermatitis, food allergies, and asthma are also commonly seen in 70% of cases and help guide diagnosis [ 3 , 4 ]. Diagnosis of EoE requires eosinophilic infiltration greater than 15 eosinophils per high power field (HPF) with endoscopic evidence of abnormal esophageal changes [ 1 , 2 ]. Generally, food allergens are the widely known etiologies of EoE; hence, treatment plans often consist of a six-food elimination diet along with topical steroids or proton-pump inhibitors to manage and decrease future recurrence of the disease [ 1 , 2 ].…”