First Case of Esophagitis Dissecans Superficialis in an HIV Patient: A Case Report and Literature Review

Abstract

Esophagitis dissecans superficialis (EDS), a rare desquamative esophageal disease of uncertain etiology, is characterized by sloughing of fragments of esophageal mucosa. To the best of our knowledge, there has been no reported case of EDS in an HIV-infected patient. We report the first case of EDS in an adult HIV-infected male, who was hospitalized due to dysphagia. Esophagogastroscopy was performed, and the endoscopic findings together with the histopathologic findings of esophageal tissues were consistent with EDS. However, his symptom of dysphagia was not explained by EDS, but was the early symptoms of muscle-specific kinase (MuSK) myasthenia gravis (MG) that we finally diagnosed later by progression of the symptoms and electrophysiologic study. His symptoms had gradually improved after a course of intravenous immunoglobulin treatment. This is the first case of EDS and MuSK myasthenia gravis in an HIV-infected patient. A high index of suspicion of EDS should be made when taking care of the patients with desquamative or sloughing esophagitis especially with unknown etiology.

Esophagitis Dissecans Superficialis in Children

“…Esophagitis dissecans superficialis is also referred to as ''sloughing esophagitis'' or ''esophagitis dessicans.'' It has been reported in older debilitated adults with chronic medical conditions who were taking multiple medications (1,3,10). It is now known that this entity can occur in younger adults and children, with or without the presence of underlying conditions and regardless of medication intake (8,9).…”

“…EDS has been described in association with numerous underlying conditions (autoimmune bullous dermatosis, collagen vascular disorders, esophageal strictures, celiac disease), with chemical or thermal irritants, and certain medications (bisphosphonates, nonsteroidal anti-inflammatory drugs, potassium chloride), but the exact etiology remains unclear (1,3,(5)(6)(7). In general, EDS is considered a benign condition without long-term consequences (1)(2)(3).…”

“…Nonspecific esophageal symptoms, such as dysphagia, heartburn, and odynophagia have been described. Patients may also be asymptomatic, with the entity identified as an incidental finding (1,3). The earliest reports date back several decades; dramatic clinical presentations include patients vomiting large tubular casts of esophageal epithelium (4).…”