WBR0592
| Author | [[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Yazan Daaboul, M.D.)]] |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Pathology |
| Sub Category | SubCategory::Gastrointestinal |
| Prompt | [[Prompt::A 41-year-old man presents to the physician's office complaining of dysphagia. A full history and appropriate physical examination are conducted, and appropriate work-up is initiated. Esophagogastroduodenoscopy (EGD) is performed and representative sample of esophageal biopsy are obtained. The next day, biopsy demonstrates the findings shown in the image below. What is the most likely primary diagnosis of this patient's condition?
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| Answer A | AnswerA::Gastroesophageal reflux disease (GERD) |
| Answer A Explanation | AnswerAExp::EoE is associated with GERD, but the endoscopic findings of the patient are characteristic of EoE. |
| Answer B | AnswerB::Peptic stricture |
| Answer B Explanation | AnswerBExp::Peptic strictures may be a consequence of EoE. Nonetheless, the image shown is characteristic for EoE. |
| Answer C | AnswerC::Eosinophilic esophagitis |
| Answer C Explanation | AnswerCExp::The image shows eosinophilic infiltrates characteristic of EoE. |
| Answer D | AnswerD::HIV esophagitis |
| Answer D Explanation | AnswerDExp::The eosinophilic predominance in the image makes viral etiology unlikely. |
| Answer E | AnswerE::HSV esophagitis |
| Answer E Explanation | AnswerEExp::The eosinophilic predominance in the image makes viral etiology unlikely. |
| Right Answer | RightAnswer::C |
| Explanation | [[Explanation::Eosinophilic esophagitis (EoE) is an emerging pathological entity that has first been described fairly recently. It is characterized by a chronic allergic inflammation of the esophagus. Typically, presents present with symptoms similar to symptoms of GERD, such as dysphagia, but are often refractory to proton pump inhibitor (PPI) therapy. Although it is more common among children and young adults, EoE may manifest at any age. The exact cause of EoE remains unknown, but it is thought to be a combination of genetic and unclear environmental factors, including food allergies. It is difficult to distinguish EoE from GERD or peptic strictures by mere clinical suspicion; thus, endoscopy with biopsy is required for definitive diagnosis. Endoscopy often demonstrates nonspecific esophageal erythema and rings around the esophageal wall. Biopsy demonstrates characteristic infiltration of eosinophilic cells into the non-keratinized stratified squamous epithelium of the esophagus with formation of microabscesses and expansion of the basal layer. Treatment is by diet therapy, PPI to reduce the symptoms associated with esophageal inflammation, topical corticosteroids (e.g. swallowed fluticasone). esophagel dilatation for strictures. The efficacy of either systemic corticosteroids or anti-histamines is still unknown and is currently being evaluated. Educational Objective: Eosinophilic esophagitis is characterized by the presence of eosinophilic infiltrates in the esophageal mucosa with thickening of the basal layer. |
| Approved | Approved::No |
| Keyword | WBRKeyword::Eosinophilic, WBRKeyword::Esophagitis, WBRKeyword::Dysphagia, WBRKeyword::Eosinophilia, WBRKeyword::Endoscopy, WBRKeyword::Gastroscopy, WBRKeyword::Ring, WBRKeyword::Esophagus, WBRKeyword::Eosinophil, WBRKeyword::Eosinophils, WBRKeyword::Esophagitis, WBRKeyword::Difficulty, WBRKeyword::Swallowing, WBRKeyword::HSV, WBRKeyword::HIV, WBRKeyword::Strictures, WBRKeyword::Stricture, WBRKeyword::Peptic, WBRKeyword::Gastroesophageal, WBRKeyword::Reflux, WBRKeyword::Disease, WBRKeyword::GERD |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |
