Esophageal Lichen Planus: An Underdiagnosed Cause of Dysphagia - A Case Report
Abstract
Esophageal lichen planus (ELP) is an underdiagnosed inflammatory condition of the esophagus with premalignant potential. We present a 75-year-old female with established mucocutaneous lichen planus who presented with one year of heartburn and epigastric discomfort refractory to acid suppression, progressing to dysphagia and weight loss. Initial barium esophagogram was unremarkable. Esophagogastroduodenoscopy revealed oral lichen planus, proximal esophageal stricture, mucosal rings (trachealization), and esophagitis dissecans superficialis with mucosal sloughing. Histopathology demonstrated band-like lymphocytic infiltrate, interface dermatitis, and Civatte bodies, confirming ELP. She was treated with budesonide slurry and esophageal dilation with initial improvement. Symptoms recurred upon steroid tapering, requiring repeat dilation and prolonged maintenance therapy. This case highlights the diagnostic challenges of ELP, which mimics gastroesophageal reflux disease and eosinophilic esophagitis, and underscores the need for high clinical suspicion in patients with mucocutaneous lichen planus and unexplained dysphagia. Given its association with esophageal squamous cell carcinoma, long-term endoscopic surveillance is essential.
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