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TL;DR
This case report describes a 14-year-old boy who developed spontaneous esophageal intramural dissection, a rare complication of long-standing, undiagnosed eosinophilic esophagitis, which was successfully managed with medical therapy.
JPGN Reports · 5 authors, 5 centres
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This case report describes a 14-year-old boy who developed spontaneous esophageal intramural dissection, a rare complication of long-standing, undiagnosed eosinophilic esophagitis, which was successfully managed with medical therapy.
The paper presents a case of a 14-year-old male with a history of food allergy and GERD who presented with acute chest pain. Initial biopsies did not show the typical eosinophilic infiltration of eosinophilic esophagitis (EoE), possibly due to subepithelial fibrosis from a prolonged diagnostic delay. The patient was treated with a proton pump inhibitor, topical steroids, and a food elimination diet, leading to mucosal healing at 1-month follow-up. Recurrent symptoms and subsequent endoscopy at 6 months confirmed the diagnosis of EoE. The case highlights that EoE can present as a rare complication like esophageal intramural dissection, and that diagnostic biopsies may be inconclusive in advanced fibrostenotic disease. The authors suggest early endoscopic evaluation for children with persistent GERD symptoms to avoid diagnostic delay.