P1412 - Concomitant Candidiasis and Lichen Planus Diagnosed in the Absence of Cutaneous Manifestations

Karim T. Osman, MD¹, Ahmed M. Abdelfattah, MD¹, Lina Elkhabiry, ², Lei Li, MD¹, Khadija Chaudrey, MD^1
1Lahey Hospital and Medical Center, Burlington, MA; ²University of Alexandria, Alexandria, Al Iskandariyah, Egypt

Introduction: Esophageal lichen planus (ELP) has been rarely reported without extraesophageal manifestations of lichen planus. Furthermore, there have been scant reports associating a correlation between ELP and fungal esophagitis. We present an interesting case of dysphagia secondary to ELP and fungal esophagitis in a patient without any other manifestations of lichen planus.

Case Description/Methods: An 85-year-old female with no pertinent medical history presented with a 5-month history of dysphagia to solids. Barium swallow showed circumferential narrowing and stricture of the lower cervical esophagus. Esophagogastroduodenoscopy (EGD) demonstrated proximal esophageal stenosis of 7 mm. Concentric rings, whitish plaques, and esophagitis were seen. Biopsies were consistent with esophageal candidiasis. Symptoms did not improve despite nystatin treatment and repeat EGD showed 9 mm stenosis that was empirically dilated to 12 mm. Diffuse mucosal changes characterized by sloughing were found at the level of the stenosis (Figure 1A). Biopsies were consistent with ELP (Figure1 B-D). She was treated with a 2-month course of oral budesonide. On 3-month follow-up, the patient endorsed significant improvement of symptoms.

Discussion: ELP commonly presents as dysphagia/odynophagia in middle-aged women. Localized involvement of the proximal esophagus helps in including ELP higher on the differential. Lichenoid lymphoid infiltrate in the lamina propria and basal epithelium, along with Civatte bodies indicate ELP. Concomitant fungal infection has been observed in 2 cases of ELP in the literature – it was hypothesized that ELP could predispose to a secondary fungal infection. Similarly, our case had a concomitant diagnosis of fungal esophagitis and ELP. In conclusion, ELP must be considered in the differential of dysphagia, even in the absence of cutaneous manifestations. More observational studies are needed to confirm a temporal association between ELP and fungal esophagitis.


Figure: Figure 1. (A) Proximal Esophageal Stricture with White Plaques; (B) Low Power View shows Squamous Mucosa with Subepithelial Blistering; (C) Mixed Neutrophilic and Lymphocytic Infiltration in the Epithelium and Subepithelial Tissue; (D) Rare Apoptotic Bodies Present in the Squamous Mucosa


Disclosures:
Karim Osman indicated no relevant financial relationships.
Ahmed Abdelfattah indicated no relevant financial relationships.
Lina Elkhabiry indicated no relevant financial relationships.
Lei Li indicated no relevant financial relationships.
Khadija Chaudrey indicated no relevant financial relationships.


Karim T. Osman, MD¹, Ahmed M. Abdelfattah, MD¹, Lina Elkhabiry, ², Lei Li, MD¹, Khadija Chaudrey, MD¹. P1412 - Concomitant Candidiasis and Lichen Planus Diagnosed in the Absence of Cutaneous Manifestations, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.