Unusual Cause of Dysphagia in a Middle Age Male

Dysphagia is not uncommon in gastroenterology practice. The differential diagnosis is wide and includes both mechanical and motility causes. Esophageal lichen planus is uncommon but now increasingly recognized. It occurs in more than half of cases of lichen planus with muco-cutaneous involvement. Often there is a delay in diagnosis and subsequent treatment. The endoscopic picture of esophageal lichen planus closely mimics that of eosinophilic esophagitis. However, histological picture is entirely different and useful for differentiating between the two. We present here a challenging case where characteristic oral lesions provided with the first clue to the diagnosis of esophageal lichen planus. Subsequent histo-pathological findings were characteristic and confirmed the diagnosis.