Lichen planus—A rare cause for dysphagia

Excerpt

A 44-year-old lady with a medical history of oral lichen planus presented with dysphagia for solid foods for three months. Endoscopy showed a stricture of the upper part of the esophagus (Fig. 1). Biopsies were taken that showed a prominent band-like and nodular infiltrate of lymphocytes involving the lamina propria and the interface of the basal epithelium with disruption of the dermal collagen layer (Fig. 2, panel a), elements of dyskeratotic keratinocytes (Civatte bodies, red arrow), which are formed by intraepithelial T cells and degenerating keratinocytes with exocytosis of lymphocytes in the epithelium (Fig. 2, panel b). Furthermore, there was positivity for T cell marker CD3 (Fig. 2, panel c), microspongiosis (light blue arrow), nuclear dyskeratosis (dark blue arrow) and lymphocytic exocytosis (green arrow) (Fig. 2, panel d). According to the clinical history, the findings were interpreted to be consistent with esophageal lichen planus and no other staining was done to rule out immunobullous disorders. The patient started treatment with prednisolone 40 mg/day with tapering, she underwent two sessions on dilation and her symptoms improved.

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