Ulcerous Esophagitis in a Young Immunocompetent Patient

ttp://dx.doi.org/10.1016/j.jpge.2016.02.004 341-4545/© 2016 Sociedade Portuguesa de Gastrenterologia. Published C BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4 owel syndrome (IBS). The patient denied regular mediation or recent use of any drugs, namely antibiotics or on-steroidal anti-inflammatory drugs. Laboratory studies howed an increased C-reactive protein and a negative HIV erology. An esophagogastroduodenoscopy (EGD) revealed everal ulcers in the lower third of the esophagus, the largest ith 15 mm and raised borders (Fig. 1). Biopsies were taken rom the edges and bottom of the ulcer. The patient was dmitted and empirically started on proton pump inhibitor PPI) and acyclovir. Serologies ruled out HSV 1 and 2, CMV, BV and VZV recent infections and syphilis. Histological xamination showed an intense chronic inflammatory infilrate involving the mucosal, submucosal and muscular layers Fig. 2a) and an epithelioid granuloma with a giant cell Fig. 2b). There were no viral cytopathic effects or acid-fast acilli. Hence, our patient had a non-caseous esophageal ranulatomatosis. We excluded tuberculosis, sarcoidosis and ranulomatosis with polyangiits (Wegener’s granulomatosis) ased on a negative Mantoux and IGRA tests and normal hest X-ray, angiotensin conversion enzyme levels, serum lectrophoresis and renal function. At this point, we conidered the hypothesis of Crohn’s disease and given the atient’s complaints of intermittent diarrhea and abdominal iscomfort, labeled as IBS, an ileocolonoscopy was perormed. Several areas of erythema with aphthous erosions, nd ulcers, stellar and circular, the largest with 10 mm,