Trachealisation of the Oesophagus in Lymphocytic Oesophagitis: An Uncommon Endoscopic Presentation

TL;DR

A rare case of lymphocytic oesophagitis presented with trachealisation, showing the importance of histopathology for diagnosis.

Contribution

Describes an unusual endoscopic feature (trachealisation) in lymphocytic oesophagitis, expanding its known presentation.

Findings

Trachealisation of the oesophagus was observed in a patient with lymphocytic oesophagitis.

Histopathology confirmed florid lymphocytic oesophagitis with apoptotic keratinocytes.

Swallowed budesonide improved symptoms and weight stabilisation in the patient.

Abstract

Lymphocytic oesophagitis (LyE) is a rare histopathological diagnosis with variable and often non-specific endoscopic features. Oesophageal rings and trachealisation are typically associated with eosinophilic oesophagitis but are uncommonly described in LyE. We describe a 79-year-old woman who presented with progressive dysphagia and unintentional weight loss. Endoscopic examination demonstrated trachealisation of the oesophagus, while histopathological evaluation confirmed florid lymphocytic oesophagitis with apoptotic keratinocytes. The patient exhibited only partial symptom relief with proton pump inhibitor (PPI) therapy; however, induction with swallowed budesonide resulted in marked clinical improvement and weight stabilisation. This case highlights an unusual endoscopic manifestation of LyE, expanding the recognised phenotypic spectrum of this entity and emphasising the essential role of histopathological evaluation in distinguishing oesophagitis subtypes.

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