P3350 - Lichen Planus: A Rare Cause of Dysphagia in a Young Man

Rei Mitsuyama, MD¹, Breton Roussel, MD¹, Jim ChunHao. Lee, MD, MPH^2
1Brown University, Providence, RI; ²Rhode Island Hospital, Providence, RI

Introduction: Lichen planus (LP) is a chronic inflammatory condition involving skin and mucous membranes typically diagnosed in middle-aged women. Skin lesions are more common, but mucosal lesions may occur even in their absence. Esophageal involvement is rare. We report an unusual case of esophageal lichen planus (ELP) causing recurrent strictures and dysphagia in a young man.

Case Description/Methods: A 38-year-old male presented with progressive dysphagia. EGD showed esophageal stricture with histologic appearance of candida esophagitis for which he was treated with fluconazole. He returned two years later with recurrent dysphagia. Repeat EGD demonstrated multiple strictures which were treated with balloon dilation. Biopsies of the distal and mid esophagus revealed intraepithelial lymphocytosis and civatte bodies. He also underwent evaluation of a new pruritic papular rash and oral mucosal hyperkeratotic plaques. Skin biopsies were non-diagnostic, but given gross appearance of cutaneous and oral lesions in conjunction with esophageal biopsy, he was started on subcutaneous methotrexate (MTX) for diffuse LP. Both MTX and subsequent adalimumab were discontinued as they were ineffective for his cutaneous lesions. While off systemic therapy, the patient experienced recurrent dysphagia, which was again treated with endoscopic dilation. Biopsies again revealed intraepithelial lymphocytosis and he was started on oral topical fluticasone. Six weeks later, symptoms had resolved and mucosa appeared improved on repeat EGD.

Discussion: ELP is a rare cause of esophageal stricture and dysphagia. Esophageal manifestations of LP may present before cutaneous lesions and patients may have multiple negative biopsies, which can lead to significant delay in diagnosis. ELP is considered a premalignant condition for squamous cell carcinoma, highlighting the importance of prompt diagnosis. Endoscopic findings can include friable mucosa, pseudomembranes, and white streaks or plaques. Histologic findings vary widely but civatte bodies are a hallmark of lichen planus. Treatment includes topical steroids, systemic immunosuppression, systemic retinoids, serial endoscopic dilations, or a combination of modalities.

Accurate diagnosis of esophageal lichen planus is crucial given its therapeutic and prognostic implications. A high index of suspicion is necessary especially when the patient does not fit classic demographics.


Disclosures:


Rei Mitsuyama, MD¹, Breton Roussel, MD¹, Jim ChunHao. Lee, MD, MPH². P3350 - Lichen Planus: A Rare Cause of Dysphagia in a Young Man, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.