Hemorrhagic esophagitis caused by chewing areca nut

Abstract

Background: Eosinophilic esophagitis arising from edibles is unusual while acute esophageal variceal hemorrhage and mediastinal hematoma caused by food consumption are even rarer. These underlying conditions may lead to severe deasease patterns, which can lead to dire consequences when untreated or mistreated. Case presentation: A 62-year-old male presented with precordial catch syndrome, chest pain and dyspnea, yet stable vital signs. The patient was initially misdiagnosed with acute coronary syndrome in a local hospital and treated for it. However, during treatment the symptoms gradually worsened. After transfer to our hospital, medical history and eating habits were explored. The medical history was unremarkable. However, one of his eating habits was chewing of areca nuts. Based on this, the clinical manifestations and examination, he was diagnosed with food-induced acute eosinophilic esophagitis and esophageal hematoma. The patient responded to treatment by food and fluid restriction, prevention of infection, inhibition of gastric acid, parenteral nutrition, and glucocorticoids well, recovered completely and could be discharged soon after. Conclusion: As an esophagitis is mostly asymptomatic, it is often overlooked or misdiagnosed, which delays treatment. The rarer condition of eosinophilic esophagitis and its complications are challenging to diagnose and thus, the careful collection of medical history as well as eating habits and their evaluation in combination with clinical manifestations and examination are anticipated to avoid misdiagnosis considerably.