First Case of Esophagitis Dissecans Superficialis in an HIV Patient: A Case Report and Literature Review

Table 1

A summary of all 30 cases with esophagitis dissecans superficialis (EDS).

Patient	Gender/age (year)	Race	Presentation	Diagnosis and associated condition	Endoscopic finding	Histology	Treatment	Outcome
1 [8]	F/81	Canadian	Chronic intermittent dysphagia	No significance	A thin white membrane lifting from mucosa	Mild candidal esophagitis; splitting of squamous mucosa at suprabasal and superficial layers; focal lymphocytic infiltration at deepest surfaces and diffuse parakeratosis	Double dose of PPI	Improvement
2 [9]	M/51	NA	Intermittent heartburn, anorexia, and epigastric pain without dysphagia	NSAID use	A thin white membrane lifting from mucosa with necrotic zones located on the lower esophagus	Detached superficial strips of squamous epithelium; prominent parakeratosis; acute inflammation and spongiosis in deep layers of squamous epithelium	Double dose of PPI	Endoscopic resolution 2 weeks after treatment
3 [10]	F/76	Belgian	Weight loss and nausea	COPD, CABG, hypertension	Fibrotic and sclerotic aspect of distal third of the esophagus	Sloughing of superficial layer of esophageal epithelium; presence of eosinophils on surface	No	Improvement
4 [10]	F/70	Belgian	Epigastric pain	Gastric bypass	White pseudomembranes of mid and distal third of the esophagus	Sloughing of superficial layer of esophageal epithelium; presence of PMN on surface separating it from basal layer	No	NA
5 [10]	F/71	Belgian	Epigastric pain	Arthrodesis L5-S1	Elevated lesion of distal third of the esophagus	Sloughing of superficial layer of esophageal epithelium; presence of eosinophils on surface	No	Improvement
6 [10]	F/47	Belgian	Dysphagia	Gastrectomy with eso-jejunal anastomosis, hypothyroidism, autoimmune pancreatitis	Sloughed esophageal mucosa in the esophagus	Sloughing of superficial layer of esophageal epithelium; presence of a few bacterial colonies on surface	No	Improvement
7 [10]	F/77	Belgian	Epigastric pain	Hypertension, hypercholesterolemia, hepatitis C, OSA	Sloughing of esophageal mucosa in the distal two-third esophagus	Sloughing of superficial layer of esophageal epithelium separated from normal basal layer	No	Improvement
8 [10]	M/86	Belgian	Atypical chest pain	Hypertension, hyperuricemia	Grade A reflux esophagitis	Sloughing of superficial layer of esophageal epithelium separated from normal basal layer	No	NA
9 [10]	F/83	Belgian	Dysphagia	Hypertension hypothyroidism, Alzheimer disease, DVT	Suspicion of an esophageal tumor from 16 to 24 cm of dental arch, circumferential from 18 to 20 cm	Sloughing of superficial layer of esophageal epithelium, presence of PMN on surface separating it from basal layer	No	Improvement
10 [7]	F/42	Portuguese	Dysphagia	Type 1 diabetes mellitus, clindamycin treatment for diabetic foot	Sloughing reddish membranes in the distal esophagus, adjacent to intact easily removed mucosa	Squamous epithelium detached from underlying basal layer; preservation of remaining layers; mild parakeratosis; severe acute inflammation with some eosinophils	Double dose of PPI	Improvement
11 [5]	F/59	USA	Dysphagia and odynophagia	Hypersensitivity pneumonitis, bisphosphonate	Sloughing whitish membranes that were easily removed, adjacent to intact healthy mucosa	Parakeratosis and desquamation of epithelial layer	Bisphosphonate discontinuation	Improvement
12 [4]	M/46	Caucasian	Nausea, vomiting, regurgitation	Hypertension, NSAID use	Distinct features of denuded mucosal lining, stripped off mucosa, long mucosal breaks, linear furrows, and vertical fissures	Fragments of superficial epithelium, parakeratosis; coagulative necrosis with epithelial sloughing	Double dose of PPI; NSAID discontinuation	Improvement
13 [4]	F/42	Caucasian	Dysphagia, regurgitation	GERD	Distinct features of denuded mucosal lining, stripped off mucosa, long mucosal breaks, linear furrows, and vertical fissures	Fragments of superficial epithelium, parakeratosis; coagulative necrosis with epithelial sloughing	Single dose of PPI	Improvement
14 [4]	F/79	African American	Dysphagia, nausea, vomiting	GERD, bullous pemphigoid, diabetes	Distinct features of denuded mucosal lining, stripped off mucosa, long mucosal breaks, linear furrows, and vertical fissures	Fragments of superficial epithelium, parakeratosis; coagulative necrosis with epithelial sloughing	Single dose of PPI	Improvement
15 [4]	F/46	African American	Dysphagia, dyspepsia	GERD, hypertension, diabetes	Distinct features of denuded mucosal lining, stripped off mucosa, long mucosal breaks, linear furrows, vertical fissures	Fragments of superficial epithelium, parakeratosis; coagulative necrosis with epithelial sloughing	Double dose of PPI	Improvement
16 [4]	F/55	Hispanic	Heartburn	GERD, hypertension, NSAID use	Distinct features of denuded mucosal lining, stripped off mucosa, long mucosal breaks, linear furrows, and vertical fissures	Fragments of superficial epithelium, parakeratosis; coagulative necrosis with epithelial sloughing	Single dose of PPI; NSAID discontinuation	Improvement
17 [1]	M/61	White	Dysphagia	NA	Diffuse erythema, patches of peeling mucosa in the mid to distal esophagus	Parakeratosis; fragments of necrotic epithelium with minimal inflammation; intraepithelial splitting at varying degrees above basal layer	Double dose of PPI	Improvement
18 [1]	M/81	African American	UGIB	NA	Multiple patches of peeling mucosa	Parakeratosis; fragments of necrotic epithelium with minimal inflammation; intraepithelial splitting at varying degrees above basal layer	Double dose of PPI	Improvement
19 [1]	M/77	African American	Weight loss	NA	Distal 2 cm patch of peeling mucosa	Parakeratosis; fragments of necrotic epithelium with minimal inflammation; intraepithelial splitting at varying degrees above basal layer	Double dose of PPI	NA
20 [1]	M/65	White	Dysphagia	NA	Grade 4 esophagitis	Parakeratosis; fragments of necrotic epithelium with minimal inflammation; intraepithelial splitting at varying degrees above basal layer	Double dose of PPI	Improvement
21 [1]	M/60	African American	UGIB	NA	Grade 3 esophagitis from the mid to distal esophagus	Parakeratosis; fragments of necrotic epithelium with minimal inflammation; intraepithelial splitting at varying degrees above basal layer	Double dose of PPI	Improvement
22 [1]	M/57	African American	Epigastric pain	NA	Distal multiple patches of peeling mucosa	Parakeratosis; fragments of necrotic epithelium with minimal inflammation; intraepithelial splitting at varying degrees above basal layer	Double dose of PPI	NA
23 [1]	F/49	White	Heartburn	NA	Mid to distal grade 3 esophagitis, achalasia	Parakeratosis; fragments of necrotic epithelium with minimal inflammation; intraepithelial splitting at varying degrees above basal layer	Double dose of PPI	Improvement
24 [1]	M/65	White	Anemia	NA	Mid to distal grade 4 esophagitis	Parakeratosis; fragments of necrotic epithelium with minimal inflammation; intraepithelial splitting at varying degrees above basal layer	Double dose of PPI	NA
25 [1]	M/80	White	Iron deficiency anemia	NA	Mid to distal grade 4 esophagitis	Parakeratosis; fragments of necrotic epithelium with minimal inflammation; intraepithelial splitting at varying degrees above basal layer	Double dose of PPI	NA
26 [1]	M/84	White	UGIB	NA	Sloughing of entire esophagus	Parakeratosis; fragments of necrotic epithelium with minimal inflammation; intraepithelial splitting at varying degrees above basal layer	Double dose of PPI	NA
27 [1]	M/63	White	Dysphagia	NA	Multiple patches of peeling mucosa in the mid to distal esophagus	Parakeratosis; fragments of necrotic epithelium with minimal inflammation; intraepithelial splitting at varying degrees above basal layer	Double dose of PPI	NA
28 [1]	M/84	White	Weight loss	NA	Distal adherent yellow patches of peeling mucosa	Parakeratosis; fragments of necrotic epithelium with minimal inflammation; intraepithelial splitting at varying degrees above basal layer	Double dose of PPI	NA
29 [11]	F/88	USA	UGIB	Atrial fibrillation, mitral regurgitation, post-cardiac arrest syndrome	White, linear, desquamating plaques in the distal esophagus	Sloughing of superficial layer of esophageal epithelium; presence of eosinophils on surface; parakeratosis	No	Improvement
30 (our case)	M/50	Thai	Dysphagia	HIV infection, myasthenia gravis	Circumferential white exudates with focal areas of erosions at the lower one-third esophagus without luminal stenosis or obstruction	Foci of splitting of the squamous epithelium with few intraepithelial cystic degeneration; no parakeratosis; no basal cell hyperplasia; mild acute and chronic inflammatory infiltrates with focal squamous cell hyperplasia; and normal underlying mucosa	Double dose of PPI	Improvement

COPD: chronic obstructive pulmonary disease; CABG: coronary artery bypass graft; OSA: obstructive sleep apnea; DVT: deep vein thrombosis; UGIB: upper gastrointestinal bleeding; PMN: polymorphonuclear cell; PPI: proton-pump inhibitor; NSAID: nonsteroidal anti-inflammatory drug.