Esophagitis Dissecans Superficialis Research Articles

Esophagitis dissecans superficialis: a rare cause of upper GI bleeding

BackgroundEsophagitis dissecans superficialis (EDS) is a rare desquamative esophageal condition with a wide range of presentations, from asymptomatic cases to those with severe, life-threatening symptoms. EDS has a strong association with several conditions, such as autoimmune diseases, smoking, and certain medications, although it can also occur without any apparent cause (idiopathic). Diagnosis involves a comprehensive approach, including clinical assessment (history and examination), endoscopic examination, histopathological analysis, and the exclusion of other potential causes. There is still no established standard treatment for EDS, as many cases resolve spontaneously without long-term complications.Case presentation.We present a case of a 73-year-old female with an episode of upper gastrointestinal bleeding (UGIB) due to Esophagitis dissecans superficialis, which had a favorable outcome after therapy with a proton pump inhibitor (PPI).ConclusionAlthough EDS is a rare condition, it should be considered a cause of UGIB in patients with risk factors.

S2886 Resolution of Esophagitis Dissecans Superficialis by a Short Course of PPI – Two Case Reports With Literature Review

S2886 Resolution of Esophagitis Dissecans Superficialis by a Short Course of PPI – Two Case Reports With Literature Review

Sometimes Things Look Worse Than They Are: Case Report of Esophagitis Dissecans Superficialis

Esophagitis dissecans superficialis is a rare and benign disorder of the esophagus that can appear severe and frightening at first glance. It is characterized by the extensive desquamation of the mucosal epithelium and the formation of tubular casts. This case report presents a 66-year-old female patient complaining of persistent phlegm and acid reflux, who was diagnosed with esophagitis dissecans superficialis on endoscopy.

212 - Esophagitis dissecans superficialis in a pancytopenic pediatric patient with mucositis

212 - Esophagitis dissecans superficialis in a pancytopenic pediatric patient with mucositis

S2442 A Rare Finding of a Common Disorder

Introduction: Esophagitis dissecans superficialis (EDS) is a rare desquamative disorder of the esophagus, characterized by sloughing of the esophageal squamous mucosa. Most cases of EDS have been associated with autoimmune bullous dermatoses, medications like bisphosphonates, chemical irritants, iatrogenic injury, and celiac disease. To our knowledge, EDS has not previously been reported with achalasia. Case Description/Methods: Our patient is a 42-year-old woman with Hashimoto’s thyroiditis and untreated achalasia type II diagnosed on high-resolution manometry 4 years ago who presented to the hospital with dysphagia to both solids and liquids and oral intake intolerance for one week. She also endorsed weight loss, nausea, and vomiting clear secretions mixed with thick white cord-like material. Physical exam was remarkable for dry mucous membranes. Laboratory tests were notable for mild leukocytosis. Given her history of achalasia and progressive symptoms, esophagogastroduodenoscopy (EGD) was performed and showed large fragments of mucosal sloughing in the distal esophagus or “tissue paper esophagus” consistent with EDS and hypertonic lower esophageal sphincter (Figure 1). Pneumatic dilation (PD) to 30 mm was successfully performed with improvement in symptoms. She was continued on a daily proton pump inhibitor and was doing well on her 4-month follow-up. Discussion: EDS can be an incidental finding on endoscopy or can present with a variety of symptoms, including dysphagia, odynophagia, coughing, or vomiting the sloughed esophageal mucosa like in our patient. The pathogenesis remains unclear. It might represent a mucosal reaction to various insults (iatrogenic, chemical, thermal, and immunological). Although EDS has been reported in association with certain dermatologic and gastrointestinal autoimmune diseases like celiac disease, it has not been reported in the setting of achalasia. Perhaps the possible autoimmune pathogenesis of achalasia related to antibodies against the enteric neurons contributes to its occurrence. Biopsies are recommended to rule out other etiologies such as candidiasis and squamous cell carcinoma (SCC). There is no specific treatment for EDS; a combination of acid suppression and discontinuation of the offending agent if present can result in healing. Prognosis is benign without lasting esophageal complications. In conclusion, endoscopists need to be aware of EDS in order not to mistake it for other conditions like esophagitis and SCC and to recognize its association with achalasia.Figure 1.: Sloughing of the esophageal mucosa described as "tissue paper esophagus" in esophagitis dissecans superficialis.

Esophagitis Dissecans Superficialis in Children.

Esophagitis dissecans superficialis (EDS) is a desquamative disorder of the superficial esophageal epithelium with variable clinical characteristics. Endoscopically, there is an appearance of superficial peeling of sheets of epithelium. Histologically there is 2-toned epithelium with coagulative necrosis of the superficial epithelium. Currently, there is paucity of data regarding this condition in children. A 10-year retrospective search of the pathology information system was performed for cases with a pathologic diagnosis of EDS in a tertiary care pediatric center. Demographic data, clinical history, endoscopic findings, and histopathologic reports were reviewed. Thirteen patients (9 girls; ages 3-18 years), were identified with histologic findings of EDS. Esophageal food impaction, dysphagia, vomiting, and abdominal pain were the most common presenting symptoms. Sixty-nine percentage of the patients had underlying comorbidities and 76% were on at least 1 medication chronically. Eosinophilic esophagitis (23%), inflammatory bowel disease (23%), and gastroesophageal reflux disease (GERD) (15%) were the most common associated diagnoses. Of the 13 patients, 5 had repeat endoscopies showing complete resolution of EDS with no complications. EDS is an under-recognized entity that endoscopists should be familiar with. In our series, the most prevalent associations were with food impaction and eosinophilic esophagitis (EoE). Contact injury and/or inflammation may precede the development of EDS. Pediatric EDS appears to be an incidental finding without significant morbidity or mortality.

Esophagitis dissecans superficialis associated with acute transoral paraquat poisoning: Clinical study of 15 cases.

To analyze the clinical characteristics and therapeutic effects of transoral paraquat poisoning combined with Esophagitis dissecans superficialis (EDS). A retrospective observational study was conducted on paraquat poisoning patients between January 1, 2011 and August 30, 2016 in Qilu hospital. Fifteen patients with EDS were enrolled in this study. The clinical characteristics, prognosis, and pathological features of esophageal necrosis mucosa of these patients were retrospectively analyzed and summarized. Esophageal mucosal dissection occurs mainly within 3-8 days after transoral paraquat poisoning in 15 patients. Dosage of paraquat is range from 50 to 100 ml. Most patients have physical problems with swallowing before the intramural esophageal dissection occurred. And there are other symptoms, including sore throat or dysphagia (100%), nausea and vomiting (86.7%), heartburn or upper abdominal pain (73.3%), hematemesis (60%), abdominal distension (20%) and cough frequently (6.7%). In death group, most patients demonstrate features of the multiple organ failure when the esophageal mucosal stripping happened, including lung injury, renal failure, and hepatic failure. The shape of esophageal dissection was tubular in 60%, irregular in 40%, and they vary in size. Pathological examination showed extensive injury, necrosis and hemorrhage of digestive tract epithelium, and obvious inflammatory reaction of epithelial tissue. Transoral paraquat poisoning has certain damage to the patient's esophageal mucosa, and some may be complicated with EDS, and the prognosis is poor, especially when combined with multiple organ dysfunction. Esophageal damage is mainly located in the esophageal mucosa and have different degrees. Special attention should be paid on such patients.

Nursing care of esophagitis dissecans superficialis caused by acute paraquat poisoning

The clinical data of 13 patients with esophageal dissecans superficials (EDS) induced by paraquat (PQ) in Qilu Hospital from March 2016 to April 2019 were analyzed retrospectively. EDS usually occurs on the 3rd to 9th day after taking poison, and the esophageal mucosa is different in size, color and character, in 10 cases of death, 1 case of pharyngeal pain basically disappeared on the 19th day after EDS onset, but died on the 27th day after taking poison, and 9 cases of death survived 5~19th days after taking poison, the overall cure rate was low; The pharyngeal pain symptoms of 3 surviving patients basically disappeared on day 15, 16 and 17 of EDS, and all patients had no discomfort after eating, and were cured gradually.

Sloughing Mucosa in Esophagitis Dissecans Superficialis

A 29-year-old man with alcohol abuse presented to the emergency department for multiple episodes of hematemesis. He did disclose epigastric pain and gastroesophageal reflux. He was hemodynamically stable with hemoglobin of 12.8 g/dL. An upper endoscopy revealed a striking sloughing of mucosa into sheets and casts in the distal esophagus (Figures A and B), consistent with a diagnosis of esophagitis dissecans superficialis (EDS). He was treated with bowel rest and acid suppression, and his symptoms resolved over 2 days.

1747 Rare Case of Esophagitis Dissecans Superficialis Mimicking Eosinophilic Esophagitis Treated With PPI

INTRODUCTION: Esophagitis dissecans superficialis (EDS) is a rare condition characterized classically by sloughing of the esophageal mucosa. EDS is a benign condition that usually resolves without lasting pathology. EDS can be associated with medications, chemical irritants, hot beverages, autoimmune diseases. Here we present a case of EDS which mimicked Eosinophilic esophagitis on endoscopy. CASE DESCRIPTION/METHODS: 76 y old male with PMH of CAD on ASA presented with chief complain of dysphagia to solid food underwent EGD that revealed mucosal friability, non-obstructing Schatzki ring, faint mucosal rings. The esophagus was dilated with 18 Fr savory dilator. Biopsies from mid and distal esophagus showed nonspecific inflammation with no intramucosal eosinophils. EGD was repeated 3 months later while he was taking PPI BID. Repeat EGD showed esophagus with circumferential rings, congestions, friability and a thin white membrane lifting from the mucosa. Biopsies from mid and distal esophagus showed splitting of squamous mucosa, focal lymphocytic infiltration and diffuse parakeratosis consistent with EDS. He was continued with PPI BID with the improvement of symptoms. DISCUSSION: Classical EDS has been characterized by stripped, whitish mucosa with or without bleeding, vertical fissures and circumferential cracks. EDS is associated with medications such as bisphosphonates or NSAIDs, chemical irritants, celiac disease, hot beverages, autoimmune bullous dermatoses or idiopathy. Commonly presents as dysphagia, anemia, pain, and heartburn. It is unclear if 81 mg ASA taken by our patient is a culprit, as he did not have any other known risk factor. Treatment includes PPI and discontinuing precipitating factors and medications. In this case, endoscopic findings initially mimicked EoE, however, repeat EGD with biopsies revealed underlying EDS.

1734 An “Off the Wall” Case of Sloughing Esophagitis

INTRODUCTION: Esophagitis dissecans superficialis (EDS), or sloughing esophagitis, is a rare, benign disease characterized by large, longitudinal sheets of sloughing mucosa visualized on upper endoscopy. Symptoms typically vary and include dysphagia, odynophagia, abdominal pain, and dyspepsia. EDS has been associated with medications, chemical and thermal irritants, autoimmune bullous dermatoses, and celiac disease. However, its pathogenesis is still poorly understood. We present a case of EDS in a patient with multiple comorbid autoimmune disorders including type 1 diabetes mellitus, Hashimoto’s thyroiditis, and celiac disease. CASE DESCRIPTION/METHODS: A 22 year old female was admitted with diabetic ketoacidosis (DKA), dysphagia, abdominal discomfort and weight loss. Her medical history included poorly controlled type 1 diabetes mellitus, celiac disease, and Hashimoto’s thyroiditis. Her upper gastrointestinal symptoms led to anorexia and unintentional weight loss. After resolution of DKA, Gastroenterology was consulted for evaluation of her symptoms. Upper endoscopy was performed which revealed mild esophagitis, mild gastritis, and scalloping in the duodenum. Esophageal biopsies demonstrated fragments of squamous mucosa with features consistent with "sloughing esophagitis". Her appetite eventually improved with initiation of proton pump inhibitor therapy and management of her poorly controlled diabetes. On outpatient follow up, her upper GI symptoms continued to improve and her weight stabilized. DISCUSSION: EDS is a rare endoscopic finding of white plaques in vertical columns that represent sloughing of large fragments of squamous tissue. Histologically, the most common features of EDS are parakeratosis, pauci-immune intraepithelial sloughing, and intraepithelial splitting. The pathogenesis of EDS is not fully understood though has been associated with autoimmune skin disorders and celiac disease. There are no specific treatments for EDS as it is usually self-limited. We present a case of sloughing esophagitis in a patient with multiple pre-existing autoimmune diseases including type 1 diabetes mellitus, Hashimoto’s thyroiditis, and celiac disease. This case is unique in that she has a polyglandular like autoimmune disorder. This suggests that autoimmunity may play a role in the pathogenesis of EDS. Interestingly, she lacked all of the dermatologic manifestations that are most frequently associated with EDS.

1717 “Dissec-ting” the Etiology

INTRODUCTION: Esophagitis dissecans superficialis (EDS) was first described in 1892. It is a rare and benign desquamative disorder characterized by sloughing of the esophageal mucosa. EDS has been linked to coronary artery disease, chronic kidney disease, autoimmune conditions (celiac disease and pemphigus vulgaris) and medications known to damage the gastrointestinal tract. However, most cases are idiopathic. CASE DESCRIPTION/METHODS: A 48-year-old male with a PMH of GERD presented to the Gastroenterology clinic with a 6-month history of esophageal dysphagia to solid foods. He denies any nausea, vomit, abdominal pain, hematemesis or episodes of melena. Esophagogram revealed delay of the barium tablet (Figure 1). The patient underwent an EGD showing sloughing of the mucosa in the entire esophagus along with LA grade C esophagitis (Figure 2). Biopsies were taken from the proximal and distal esophagus with findings compatible with esophagitis dissecans superficialis (Figure 3). Ranitidine and PPI were continued and he was scheduled for a follow appointment in 6 weeks. DISCUSSION: EDS is typically seen in middle aged women, and is commonly misdiagnosed due to the lack of diagnostic or histologic criteria. Endoscopic features consist of esophageal mucosa with multiple columns of strips that have whitish/pearly appearance andsloughs which are > 2 cm in length, and lack of ulcers in the surrounding mucosa. These findings can be mistaken with esophageal candidiasis, eosinophilic esophagitis, lichen planus and even squamous cell carcinoma. For this reason, the diagnosis is made through histopathologic findings such as parakeratosis and intraepithelial splitting above the basal layer. As in our patient, dysphagia is frequently reported, but nonspecific symptoms like nausea, vomiting or heartburn are also found. There are no specific treatment guidelines. Nevertheless, acid suppressants can be started to aid mucosa healing. Some patients can present with esophageal strictures, but this entity mainly follows a benign course as it shows self-resolution from 8 weeks to 4 months of diagnosis. This case shows the importance of recognizing EDS not only as an underreported cause for dysphagia, but also as an important differential diagnosis for esophageal diseases. It is important to obtain mucosal biopsies in order to get a proper diagnosis and avoid unnecessary treatments.

1768 Esophagitis Dissecans Superficialis Secondary to Ingestion of Hair Dye

INTRODUCTION: Esophagitis dissecans superficialis (EDS) is a rare and underdiagnosed esophageal lesion characterized by sloughing of the esophageal mucosa that has been associated with various autoimmune disorders and exposure to some chemical irritants. Our case highlights a 65-year-old woman diagnosed with EDS after incidental ingestion of hair dye containing resorcinol and paraphenylenediamine (PPD). CASE DESCRIPTION/METHODS: The patient is a 65 year-old female with a medical history of diabetes, hypertension, major depressive disorder, asthma, alcohol use disorder who presented to our emergency department complaining of nausea and vomiting after ingesting a colored hair dye. The patient stated she accidentally ingested 2 oz of hair dye believing it was cough syrup. Notable laboratory findings on admission included a complete blood count within normal limits; a venous blood gas showing a pH of 7.274; pCO2 of 39.2 mm Hg; HCO3 of 17.2 mEq/L and a lactic acid of 5.1. Notable imaging included a chest x-ray showing focal patchy opacities at both lung bases; and an X-ray of the neck showed no retropharyngeal soft tissue swelling. Physical exam was unremarkable. After initial evaluation esophagogastroduodenoscopy (EGD) was done and showed mild superficial mucosal desquamation in entire esophagus suggestive of esophagitis dissecans superficialis (Figure 1). After the procedure the patient was started on pantoprazole and admitted to the general medical floor for further monitoring. The following night the patients symptoms resolved and she was discharge with follow up appointments. DISCUSSION: PPD is an aromatic amine that is widely used in hair dye due to its favorable cosmetic outcomes. Adverse effects of PPD include cervicofacial edema, upper airway tract edema, oliguria, and shock. Resorcinol is a phenolic chemical that is also used in hair dye. Readily absorbed by the gastrointestinal tract, resorcinol is a corrosive acid that causes severe burns on direct contact. Its consumption may also result in pulmonary edema, hemolysis, and metabolic acidosis. Clinical manifestations of EDS are non-specific and include vomiting and dysphagia. Endoscopically it is characterized by sheets of sloughed squamous tissue which typically appear as multiple columns of strips, often described as "gift wrap paper" like distribution as was present in our case. Its prognosis is very favorable and long term complications are rare. To our knowledge this makes the first reported case of EDS occurring secondary to ingestion of hair dye.

Esophagitis Dissecans Superficialis Diagnosed by Unsedated Transnasal Esophagoscopy

Esophagitis Dissecans Superficialis Diagnosed by Unsedated Transnasal Esophagoscopy

Sloughing esophagitis: a spectacular histologic and endoscopic disease without a uniform clinical correlation.

Sloughing esophagitis, also currently known as esophagitis dissecans superficialis, is a degenerative disease of the squamous epithelium characterized by superficial epithelial necrosis with parakeratosis, but without inflammation, and detachment of the superficial necrotic zone from the deep viable zone. This leads to a spectacular endoscopic appearance of sloughed mucosa in streaks and patches. The cause is unknown, and the clinical characteristics are variable, ranging from incidentally findings to esophageal symptoms. The disease seems to be self-limited, as resolution of the changes was observed in the few cases for which follow-up endoscopic examinations have been reported.

Bullous Bleeding: Esophagitis Dissecans Superficialis in a Patient With Bullous Pemphigoid

Introduction: Esophagitis Dissecans Superficialis (EDS), characterized by sloughing of the esophageal epithelial lining, is a rare endoscopic finding. Causes include medications, hot beverages, celiac disease, collagen vascular diseases, idiopathy, and autoimmune bullous dermatoses (ABDs), such as Bullous Pemphigoid (BP) and Pemphigus Vulgaris (PV). Symptoms include dysphagia, odynophagia, and heartburn; vomiting of mucosal casts and hematemesis rarely occurs. We present a patient with BP and EDS with upper gastrointestinal bleeding (UGIB). Case: A 54 year-old female with a medical history of end stage renal disease, due to hypertension, status post renal allograft transplant, with graft failure on hemodialysis, presented to the emergency department (ED) with hematemesis. For 2 weeks she had worsening oral ulcerations and hematuria and 6 hours prior, she had severe nausea, burning chest pain, and 4-5 episodes of bright red vomitus. With 1 episode, she saw a “½ foot” long grayish-white soft tissue-like material. In the ED, she was hypertensive and tachycardic, with cutaneous blisters at various stages of healing. Hemoglobin was 7.1 g/dL, from 8.1 g/dL 2 weeks prior. An urgent EGD revealed mucosal sloughing involving the entire esophagus and posterior oro-pharynx, with associated clots and bleeding. Biopsy was deferred. Further history indicated she had a 4 month history of skin blisters and oral ulcerations, occurring after her transplant immunosuppresants were withdrawn, and was diagnosed with BP. Workup revealed a BP180 IgG > 150 units (normal < 9) and skin biopsy showed linear basement membrane pattern staining for IgG and C3 antibody. Her esophageal findings were attributed to her underlying BP. With PPI therapy, high-dose methylprednisolone, and mycophenolate mofetil she had significant improvement with resolution of hematemesis. A repeat endoscopic evaluation was declined. Discussion: Hematemesis with vomiting of esophageal mucosal casts is a rarely reported presentation of EDS. EDS has many potential causes, and recently, the pathophysiology and relationship between EDS and ABDs such as BP and PV have been increasingly acknowledged in the literature. Conclusion: EDS should be considered in patients who present with hematemesis and/or report of vomiting esophageal mucosal casts; endoscopic findings of exfoliative esophagitis support the diagnosis. These clinical findings should lead to consideration of ABDs as an etiology, to guide appropriate management decisions.

Esophagitis Dissecans Superficialis: An Uncommon Endoscopic Diagnosis

A 72 year old female with a history of cervical nerve impingement presented with sudden onset of odynophagia. On presentation to the emergency room, the patient reported 6 hours of severe odynophagia which was dull at rest but spastic with swallowing. Of note, the patient had recently started taking cyclobenzaprine at bedtime and had completed a course of prednisone three weeks prior for neck pain attributed to her cervical nerve impingement. She denied fevers, chills, nausea, vomiting, regurgitation, dyspepsia and abdominal pain. She had no prior surgeries. Physical exam revealed an afebrile woman in no apparent distress with normal oropharyx, pulmonary and abdominal exam. Initial laboratory studies revealed CBC and CMP within normal limits. Plain films of the neck revealed no radiopaque foreign bodies or soft tissue swelling. EGD showed long strands of friable tissue paper-like mucosa overlying normal appearing esophageal mucosa. There were no signs of esophageal narrowing or retained food. Biopsies showed diffuse superficial necrosis of the squamous mucosa with separation of the necrotic upper portion from the unremarkable viable deeper layers. Additionally, few intraepithelial eosinophils were noted. These findings were most consistent with esophagitis dissecans superficialis(EDS). The patient completed a month course of twice daily proton pump inhibitor with complete resolution of her symptoms. EDS is a desquamative disorder of the esophagus with a benign natural history that is under-recognized with less than 100 published cases. Currently the etiology of EDS is poorly understood and it has a wide range of associations. The most common pathogenesis is thought to besecondary to injury of the esophageal mucosa, specifically from medications and other caustic agents. Case reports previously had focused on the histological constellation of parakeratosis, strips of epithelium with distinct necrotic edge, and lack of inflammatory infiltrates. More recent studies have proposed a clinicopathologic diagnosis of EDS with the major diagnostic criteria being 3 key endoscopic findings of the esophageal mucosa: (1)strips of sloughed esophagus, (2)normal underlying mucosa, (3)lack of ulceration/friability of adjacent esophageal mucosa. Increased awareness of the clinical, endoscopic, and histologic features of EDS should result in greater detection rates, which will prevent unnecessary investigation and therapies while aiding in the understanding of its etiology.Figure 1Figure 2

Esophagitis Dissecans Superficialis: Clinical, Endoscopic, and Histologic Features.

Esophagitis dissecans superficialis (EDS) is a desquamative disorder of the esophagus, but there is a paucity of the literature regarding this condition. We examined our institution's experience to further characterize clinical outcomes, and endoscopic and histopathologic features. Endoscopy and pathology databases were retrospectively reviewed from 2000 to 2013 at Mayo Clinic Rochester to identify potential cases of EDS. Medical records and endoscopic images were reviewed to identify cases, and original pathologic specimens were also reviewed. Clinical, endoscopic, and histologic characteristics of EDS were defined. Forty-one subjects were identified with a median age at diagnosis of 65.0 years (IQR 52.8-76.1) and a female preponderance (63.4 %). Many patients were taking a psychoactive agent (73.1 %) or acid-suppressive therapy (58.5 %) preceding the index endoscopy. Strips of sloughed membranes had a predilection for the distal and/or middle esophagus and resolved in 85.7 % of subjects at endoscopic follow-up. Parakeratosis and intraepithelial splitting were histologic features seen in all patients, while splitting of the connective tissue and intraepithelial bullae were seen in 46.2 and 11.1 %, respectively. There were no disease-related complications at a median follow-up of 10.4 months (IQR 1.2-17.2). EDS is likely under-recognized. A distinct endoscopic feature of EDS is "sloughing" strips of mucosa with parakeratosis and intraepithelial splitting being sine qua non histologic findings. The use of psychoactive agents (particularly a SSRI or SNRI) was prevalent at endoscopic diagnosis, although the clinical relevance of this is uncertain. EDS appears to be a benign, incidental finding without complications.

Esophagitis dissecans associated with eosinophilic esophagitis in an adolescent

Esophagitis dissecans superficialis and eosinophilic esophagitis are distinct esophageal pathologies with characteristic clinical and histologic findings. Esophagitis dissecans superficialis is a rare finding on endoscopy consisting of the peeling of large fragments of esophageal mucosa. Histology shows sloughing of the epithelium and parakeratosis. Eosinophilic esophagitis is an allergic disease of the esophagus characterized by eosinophilic inflammation of the epithelium and symptoms of esophageal dysfunction. Both of these esophageal processes have been associated with other diseases, but there is no known association between them. We describe a case of esophagitis dissecans superficialis and eosinophilic esophagitis in an adolescent patient. To our knowledge, this is the first case describing an association between esophageal dissecans superficialis and eosinophilic esophagitis.

Bullous systemic lupus erythematosus associated with esophagitis dissecans superficialis.

Bullous systemic lupus erythematosus is one of the rare autoantibody mediated skin manifestation of systemic lupus erythematosus (SLE) demonstrating subepidermal blistering with neutrophilic infiltrate histologically. We present a case of a 40-year-old Hispanic female who presented with a several months' history of multiple blistering pruritic skin lesions involving the face and trunk, a photosensitive rash over the face and neck, swelling of the right neck lymph node, and joint pain involving her elbows and wrist. Her malady was diagnosed as bullous systemic lupus erythematosus based on the immunological workup and biopsy of her skin lesions. The patient also complained of odynophagia and endoscopy revealed esophagitis dissecans superficialis which is a rare endoscopic finding characterized by sloughing of the esophageal mucosa. The bullous disorders typically associated with esophagitis dissecans superficialis are pemphigus and rarely bullous pemphigoid. However, this is the first reported case of bullous systemic lupus erythematosus associated with esophagitis dissecans superficialis.