Esophagitis dissecans superficialis associated with severe clindamycin toxicity.
نویسندگان
چکیده
A 42-year-old woman with type 1 diabetes mellitus and a regular smoking habit (19 pack-years) presented with dysphagia, nausea and vomiting over the previous week, a er clindamycin treatment for infected diabetic foot ulcers. An esophagogastroduodenoscopy revealed sloughing reddish membranes in the distal esophagus, adjacent to intact healthy mucosa that were easily removed (Figs.1, 2). Histopathological evaluation showed squamous epithelium completely detached from the underlying chorion, with necrosis of basal layers and preservation of remaining layers. Mild parakeratosis and moderate to severe acute in ammation with some eosinophils (<6 eosinophils/HPF) was observed (Fig.3, H&E x200). e endoscopic and histological ndings were consistent with esophagitis dissecans super cialis (EDS). Discontinuation of clindamycin and the administration of a double-dose proton-pump inhibitor resulted in symptomatic improvement. Esophagitis dissecans super cialis is a rare benign condition described originally in 1892, characterized by super cial necrotic squamous epithelium and whitish/pale endoscopic plaques and membranes [1]. Our patient had sloughing reddish membranes, an atypical finding in EDS, possibly related to the scarce parakeratosis. is nding can be explained by the early stage of the disease and the association with clindamycin. Although the exact pathogenesis of EDS remains unexplained, some risk factors have been proposed: bisphosphonates, nonsteroidal antiin ammatory drugs, potassium chloride, esophageal strictures, heavy smoking, hot beverages, chemical irritants, nasogastric intubation, celiac disease, collagen vascular disorders and autoimmune bullous dermatoses [2, 3]. Our patient had a history IMAGE OF THE ISSUE
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عنوان ژورنال:
- Journal of gastrointestinal and liver diseases : JGLD
دوره 23 4 شماره
صفحات -
تاریخ انتشار 2014