A Case of Esophagitis Dissecans Superficialis With Concomitant Bullous Pemphgoid

Abstract

Introduction: Esophagitis dissecans superficialis is an exceedingly rare endoscopic finding characterized by sloughing of large fragments of the esophageal mucosal lining that has uncommonly been associated with autoimmune bullous dermatoses. We report a case of a 77-year-old male who presented with 2 months of upper and lower extremity bullous skin eruptions in addition to more recent odynophagia and melenic stools in the setting of ibuprofen use for analgesia. A diagnosis of bullous pemphgoid was confirmed by direct immunofluorescence which identified immunoglobulin G and complement 3 deposits at the dermoepidermal junction. Endoscopy performed the following day revealed, in addition to a 2 centimeter duodenal bulb ulcer, vertical linear fissures with sloughing of the superficial esophageal mucosa consistent with esophagitis dissecans superficialis. The patient was initially treated with intravenous methylprednisolone for 3 days, followed by a prednisone taper with improvement in his bullous skin lesions, odynophagia and melenic stools. With less than 10 cases of esophagitis dissecans superficialis associated with bullous pemphigoid described in the English literature, prompt endoscopic recognition is vital in corroborating a diagnosis and guiding therapy.Figure 1: Sloughing of large fragments of the esophageal mucosal lining.