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Case Report

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J Korean Dysphagia Soc 2024; 14(Suppl 1): 155-160

Published online December 20, 2024

© The Korean Dysphagia Society.

A Rare Case of Eosinophilic Esophagitis Accompanied by Oropharyngeal Dysphagia and Aspiration

Jisun Bae, M.D., Soohoan Lee, M.D., Jisoo Park, M.D., Hae-Yeon Park, M.D., Ph.D., Sun Im, M.D., Ph.D.

Department of Rehabilitation Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Correspondence to:Sun Im, Department of Rehabilitation Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 327, Sosa-ro, Bucheon 14647, Korea
Tel: +82-31-340-2170, Fax: +82-31-340-2173, E-mail: lafolia@catholic.ac.kr

Received: July 26, 2024; Revised: August 6, 2024; Accepted: November 8, 2024

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A 74-year-old woman presented with a progressive pattern of dysphagia and odynophagia over one month. Magnetic resonance imaging of the neck revealed diffuse swelling from the tongue base and velum extending to the posterior pharyngeal wall. Instrumental evaluation of swallowing showed decreased peristalsis in the esophageal phase, accompanied by severe swelling of the hypopharynx, which limited laryngeal elevation and subsequently led to decreased bolus clearance and impaired airway protection. Laboratory studies revealed a 61% increase in eosinophil count. An endoscopic biopsy of the esophagus confirmed the diagnosis of eosinophilic esophagitis. The patient was administered intravenous dexamethasone at a total dosage of 45 mg/day for 7 days. The eosinophil count dropped to the normal range, correlating with the improvement in dysphagia and aspiration. Eosinophilic esophagitis often presents in children and rarely involves the oropharyngeal structures. Due to its specific involvement of the esophagus, it seldom leads to aspiration. By contrast, the extension of eosinophilic inflammation from the esophagus to the oropharynx in this case resulted in atypical symptoms such as odynophagia and aspiration. The therapeutic approach can be challenging due to the difficulty in administering topical steroids, which are often the treatment of choice. However, the condition showed an excellent response to intravenous steroid therapy.

Keywords: Eosinophilia, Esophagitis, Oropharyngeal dysphagia, Deglutition, Corticosteroids

Article

Case Report

J Korean Dysphagia Soc 2024; 14(Suppl 1): 155-160

Published online December 20, 2024

Copyright © The Korean Dysphagia Society.

A Rare Case of Eosinophilic Esophagitis Accompanied by Oropharyngeal Dysphagia and Aspiration

Jisun Bae, M.D., Soohoan Lee, M.D., Jisoo Park, M.D., Hae-Yeon Park, M.D., Ph.D., Sun Im, M.D., Ph.D.

Department of Rehabilitation Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Correspondence to:Sun Im, Department of Rehabilitation Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 327, Sosa-ro, Bucheon 14647, Korea
Tel: +82-31-340-2170, Fax: +82-31-340-2173, E-mail: lafolia@catholic.ac.kr

Received: July 26, 2024; Revised: August 6, 2024; Accepted: November 8, 2024

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A 74-year-old woman presented with a progressive pattern of dysphagia and odynophagia over one month. Magnetic resonance imaging of the neck revealed diffuse swelling from the tongue base and velum extending to the posterior pharyngeal wall. Instrumental evaluation of swallowing showed decreased peristalsis in the esophageal phase, accompanied by severe swelling of the hypopharynx, which limited laryngeal elevation and subsequently led to decreased bolus clearance and impaired airway protection. Laboratory studies revealed a 61% increase in eosinophil count. An endoscopic biopsy of the esophagus confirmed the diagnosis of eosinophilic esophagitis. The patient was administered intravenous dexamethasone at a total dosage of 45 mg/day for 7 days. The eosinophil count dropped to the normal range, correlating with the improvement in dysphagia and aspiration. Eosinophilic esophagitis often presents in children and rarely involves the oropharyngeal structures. Due to its specific involvement of the esophagus, it seldom leads to aspiration. By contrast, the extension of eosinophilic inflammation from the esophagus to the oropharynx in this case resulted in atypical symptoms such as odynophagia and aspiration. The therapeutic approach can be challenging due to the difficulty in administering topical steroids, which are often the treatment of choice. However, the condition showed an excellent response to intravenous steroid therapy.

Keywords: Eosinophilia, Esophagitis, Oropharyngeal dysphagia, Deglutition, Corticosteroids

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