Abstract
IntroductionEosinophilic esophagitis was first reported in 1978, and since then it has been increasingly recognized as one of the major etiologies for dysphagia, food impaction, and food regurgitation. To the best of our knowledge, no case of eosinophilic esophagitis (excluding esophageal eosinophilia not responsive to proton pump inhibitor treatment) has previously been demonstrated on the basis of positron emission tomography imaging.Case presentationA 68-year-old Caucasian man presented with dysphagia to solids with recurrent regurgitation and weight loss of 7lb within the preceding 2 months. The patient attributed these symptoms to radiation therapy he had received 1 year earlier for squamous cell cancer of the lung. The patient underwent routine follow-up positron emission tomography imaging, which showed a hypermetabolic lesion in the posterior mediastinum and was increased at the level of the midesophagus.ConclusionTo the best of our knowledge, this is the first reported case of eosinophilic esophagitis demonstrated by positron emission tomography imaging and confirmed with endoscopic evaluation and biopsies both after positron emission tomography imaging and a trial of proton pump inhibitor therapy. This could have an impact on the diagnostic evaluation of esophageal eosinophilic inflammation as well as eosinophilic infiltration of other gastrointestinal organs.
Highlights
Eosinophilic esophagitis was first reported in 1978, and since it has been increasingly recognized as one of the major etiologies for dysphagia, food impaction, and food regurgitation
That report did not comment on proton pump inhibitor therapy (PPI) or other treatment prior to or at the time of follow-up after the PET scan
There was intense eosinophilia of the affected area of the midesophagus, with up to 80 eosinophils per high-power field (HPF) with repeat biopsies after 6wk of treatment showing more than 30 eosinophils per HPF
Summary
To the best of our knowledge, this is the first reported case of eosinophilic esophagitis demonstrated by positron emission tomography imaging and confirmed with endoscopic evaluation and biopsies both after positron emission tomography imaging and a trial of proton pump inhibitor therapy. This could have an impact on the diagnostic evaluation of esophageal eosinophilic inflammation as well as eosinophilic infiltration of other gastrointestinal organs
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