case_images: PMC11095609_01
case_images: EGD showing friable and borderline trachealised oesophageal mucosa, in the proximal (a), middle (b), and distal (c) oesophagus.
case_images: crg-2024-0018-0001-538894_F01.jpg
case_images: PMC11095609_01_crg-2024-0018-0001-538894_F01.jpg
case_images: F1
case_images: Macroscopically, the oesophageal mucosa was rigid and trachealised with a papier-mache appearance, suspicious for long-standing eosinophilic oesophagitis (EoE) (Fig. 1).
case_images: Lichenoid histologic appearance of oesophageal mucosa. a Band-like lymphocytic infiltrate at the interface of basal oesophageal epithelium and lamina propria, using HE staining (x20; 0.5 mum/pixel). b Predominance of T lymphocytes (brown CD3-positive cells) in the epithelium and lamina propria, using DAB technique (x20; 0.5 mum/pixel). c Multiple dyskeratotic degenerative keratinocytes also known as Civatte bodies (grey arrowheads), using HE staining (x20; 0.5 mum/pixel). d Oesophageal hyperkeratosis with keratinisation (arrows) and hypergranulation (arrowheads) of the squamous epithelium, using HE staining (x20; 0.5 mum/pixel).
case_images: crg-2024-0018-0001-538894_F02.jpg
case_images: PMC11095609_01_crg-2024-0018-0001-538894_F02.jpg
case_images: F2
case_images: Histopathological examination of the biopsy of the distal oesophagus revealed a lichenoid oesophagitis pattern of injury (Fig. 2), with a prominent band-like lymphocytic infiltrate involving the interface of the lamina propria and epithelium as well as Civatte bodies - apoptotic keratinocytes considered a hallmark of LP.
case_images: a Post-treatment oesophageal mucosa appears normal without any significant pathological findings, using HE staining (x20; 0.5 mum/pixel). bCandida albicans spores and hyphae (arrowheads) are observed as commensal findings on the normal oesophageal mucosa, without any associated cellular reactions, using ABPAS staining (x20; 0.5 mum/pixel).
case_images: crg-2024-0018-0001-538894_F03.jpg
case_images: PMC11095609_01_crg-2024-0018-0001-538894_F03.jpg
case_images: F3
case_images: BOT), after which the patient received fluconazole 200 mg BD for 14 days. Biopsies taken from the length of the oesophagus showed no evidence of existing oesophagitis, with an entirely normal mucosal appearance - apart from diffuse candida hyphae and spores without inflammatory response in the distal oesophagus (Fig. 3).