A Case of Plummer-Vinson Syndrome in an Afro-Caribbean Female

Abstract

Plummer-Vinson is defined by the classic triad of dysphagia, iron deficiency anemia and upper esophageal web(s). Although quite rare, and predominantly found in white, middle aged women, we report a case of PV in a middle-aged Afro-Caribbean female managed with mechanical dilation and iron supplementation. A 43 year old female presented with progressive dysphagia to liquids and solids for a duration of 2 years. Several weeks prior to presentation she reported several episodes of regurgitating undigested food. A review of systems was significant for a 50-lb weight loss, headaches and fatigue. She was given a diagnosis of anemia by her General Practitioner approximately 12 years prior to presentatiion but no additional work up was done. She denied menorrhagia, hematuria, hematochezia, and any gastrointestinal symptoms. She denied taking any NSAIDS. On examination, her blood pressure was 164/99 mmHg and her pulse rate was 67 beats per minute and regular. She was afebrile. Mucus membranes were pale but moist. Evaluation of the mouth revealed atrophic glossitis and there was pallor of the nail beds but no koilonychia. Systemic examination revealed an ejection systolic murmur over the precordium but no other abnormalities. Laboratory investigations showed a hemoglobin of 5.6 g/dl with a mean corpuscular volume of 54.9 fl. White blood cell count was 4.51 K/ul and platelets were 311,000 K/μl. The serum iron was 13 μg/dl, iron saturation 3%, and serum ferritin 3ng/mL. Alanine transaminase, serum creatinine and Thyroid Stimulating Hormone were within normal limits. A modified barium swallow revealed a short smooth segment of stenosis immediately inferior to the pharynx and anterior to the 4thcervical vertebrae. An upper endoscopy confirmed a smooth mucosal narrowing 24cm from the incisors, consistent with a mucosal web. The gastroscope was advanced with gentle pressure into the stomach and proximal duodenum; both were normal. Biopsies were taken from the gastric body and antrum and the revealed chronic active gastritis associated with intestinal metaplasia, H. pylori organisms were not identified. Multiple biopsies taken from the proximal duodenum showed no evidence of celiac disease. A Continuous Radial Expansion balloon was used to dilate the stricture to 15mm. On the first post operative day the patient had significant improvement in her symptoms and was able to tolerate a regular diet. She was discharged on Ferrous Sulphate 325mg and Vitamin C 1000mg daily. Repeat iron studies performed 8 weeks later showed a serum iron of 17 ug/dl and a serum ferritin of 6ng/ml.Figure 1Figure 2