UCTN ± Unusual cases and technical notes E171

Spontaneous esophageal perforation in eosinophilic in children

Fig. 1 a Chest computed tomography scan showing an upper third retroesophageal perforation, with a periesophageal fluid collection (20 ” 10 mm). b Esophageal . c Biopsy showing intraepithelial eosinophil aggregates.

A 9−year−old girl with a history of asthma, rare chronic inflammatory disease, with References intermittent solid food dysphagia and a varied clinical and endoscopic spec− 1 Furuta GT, Liacouras CA, Collins MH et al. blockage was admitted because of chest trum. Some age−related differences were in children and pain, pyrosis, and (38.38C). The noted between symptoms in children adults: a systematic review and consensus only medication she was on at the time and adults. In children, feeding refusal or recommendations for diagnosis and treat− of our evaluation was the inhaler Salbuta− intolerance, GERD−like symptoms, eme− ment. 2007; 133: 1342± 1363 mol−sulfate, which she used as needed. sis, abdominal pain, dysphagia, food im− 2 Ligouri G, Cortale M, Cimino F et al. Circum− Symptoms started a few hours after a paction, , and have ferential mucosal dissection and esopha− food blockage episode. Physical examina− been described [1]. In adults, intermittent geal perforation in a patient with eosino− tion was normal, except for tachycardia dysphagia and food impaction are more philic esophagitis. World J Gastroenterol (135 bpm). Laboratory results showed: common [1]. Transmural inflammation 2008; 14: 803 ± 804 3 Cohen MS, Kaufman AB, Palazzo JP et al. An leukocytosis (17300/mm3), 11.59 ” 109 has been reported in eosinophilic esopha− audit of endoscopic complications in adult neutrophils, a high C−reactive protein gitis. It significantly increases the risk of eosinophilic esophagitis. Clin Gastroenterol (180 mg/l), and erythrocyte sedimenta− perforation. Mucosal laceration and Hepatol 2007; 5: 1149± 1153 tion rate of 74 mm/h. transmural perforation have been report− 4 Gomez Senent S, Adan Merino L, Froilan Chest radiograph was normal. Chest com− ed after endoscopy or dilation in eosino− Torres C et al. Spontaneous esophageal rup− ture as onset of eosinophilic esophagitis. l" puted tomography scan ( Fig. 1a) philic esophagitis [2,3]. Gastroenterol Hepatol 2008; 31: 50 ± 51 showed a retroesophageal perforation, Spontaneous esophageal perforation was 5 Cohen MS, Kaufman A, Dimarino A et al. Eo− with periesophageal fluid collection. Ini− recently reported in three adults, asso− sinophilic esophagitis presenting as spon− tial treatment consisted of fasting, intra− ciated with eosinophilic esophagitis [2± taneous (Boerhaave’s venous antibiotics (ceftriaxone 1.5 g/d, 4]. Until now, no reports of this unusual syndrome). Clin Gastroenterol Hepatol 2007; 5: A24 metronidazole 300 mg t.i.d, gentamicin association and presentation have been 90 mg/d), and proton pump inhibitor reported in children, extending the clini− This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited. Bibliography (30 mg/d), with good evolution. Upper cal spectrum of eosinophilic esophagitis DOI 10.1055/s−2007−995801 endoscopy (l" Fig. 1 b) 2 months later in this population. Endoscopy 2008; 40: E171 showed an upper esophageal resistance Endoscopy_UCTN_Code_CCL_1AB_2AC_3AD  Georg Thieme Verlag KG Stuttgart ´ New York ´ to the tube passage without stenosis, and ISSN 0013−726X normal mucosa. Biopsies demonstrated C. Robles−Medranda1, 2, F. Villard3, very many intraepithelial eosinophil ag− R. Bouvier4, J. Dumortier1, A. Lachaux2, 3 Corresponding author 1 gregates > 20 eos/HPF (l" Fig. 1 c). Department of Hepatogastroenterolo− C. Robles−Medranda, MD Eosinophilic esophagitis is characterized gy, Hôpital Edouard Herriot, Lyon, Hôpital Edouard Herriot Department of Hepatogastroenterology by esophageal and/or upper gastrointesti− France Place d’Arsonval 2 nal tract symptoms in association with an CMR−Wilson, Edouard Herriot Hospital, 69437, Lyon esophageal mucosal biopsy containing Lyon, France Cedex 03 ³ 15 intraepithelial eos/HPF in one or 3 Pediatrics Department, Hôpital Edouard France more biopsy specimen, without patho− Herriot, Lyon, France Fax: +33−472−110147 logic gastroesophageal reflux disease 4 Pathology Department, Hôpital Edouard [email protected] (GERD) [1]. Eosinophilic esophagitis is a Herriot, Lyon, France

Robles−Medranda C et al. Esophageal perforation in eosinophilic esophagitis ¼ Endoscopy 2008; 40: E171