Huber Aaron R, Sprung Brandon S, Miller John, Findeis-Hosey Jennifer J
Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA.
Department of Medicine, Division of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, NY, USA.
Am J Case Rep. 2018 Apr 6;19:406-409. doi: 10.12659/ajcr.908255.
BACKGROUND Gastrointestinal tract mucosal calcinosis (MC) tends to affect the gastric mucosa, while esophageal involvement is rare. Gastric MC may be seen with solid organ transplantation, use of aluminum-containing antacids or sucralfate, malignancy, and chronic renal failure. While the incidence of gastric MC in renal transplant patients undergoing gastric biopsy is common (between 15-29%), to our knowledge esophageal MC has only been previously reported 3 times. CASE REPORT A 68-year-old male dialysis-dependent end stage renal disease status-post deceased donor kidney transplant underwent an esophagogastroduodenoscopy (EGD) for dysphagia and diffuse esophageal wall thickening seen on imaging studies. EGD demonstrated diffuse, circumferential thick white esophageal plaques and mucosal friability. Esophageal biopsies demonstrated erosive esophagitis with basophilic calcium deposits within the fibrinopurulent exudate and squamous mucosa. Stains for fungal organisms and viruses were negative. A diagnosis of esophageal MC was made. Although the patient had a protracted postoperative course after transplantation, he had improvement of the esophageal wall thickening on imaging after transplantation. CONCLUSIONS Esophageal MC is a rare phenomenon and all of the previously reported cases of esophageal MC, including our case, have been in patients with end stage renal disease who were on dialysis. Although prolonged hypercalcemia and hyperphosphatemia, an elevated calcium-phosphorus product, and associated underlying inflammation are likely key etiologic factors, the pathogenesis of esophageal MC is not fully understood and is likely due to multiple collective etiologies. Likewise, more reported cases are likely to increase our understanding of the clinical significance and management of this rare disorder.
胃肠道黏膜钙化症（MC）往往累及胃黏膜，而食管受累情况罕见。胃MC可见于实体器官移植、使用含铝抗酸剂或硫糖铝、恶性肿瘤及慢性肾衰竭患者。在接受胃活检的肾移植患者中，胃MC的发生率较为常见（15% - 29%），但据我们所知，食管MC此前仅报告过3例。病例报告：一名68岁男性，依赖透析的终末期肾病患者，在接受已故供体肾移植术后，因吞咽困难及影像学检查发现食管壁弥漫性增厚，接受了食管胃十二指肠镜检查（EGD）。EGD显示食管弥漫性、环形增厚的白色斑块及黏膜脆性增加。食管活检显示糜烂性食管炎，在纤维蛋白脓性渗出物和鳞状黏膜内有嗜碱性钙沉积。真菌和病毒染色均为阴性。诊断为食管MC。尽管该患者移植后病程迁延，但移植后影像学检查显示食管壁增厚有所改善。结论：食管MC是一种罕见现象，包括我们的病例在内，所有此前报告的食管MC病例均为接受透析的终末期肾病患者。尽管长期高钙血症、高磷血症、钙磷乘积升高及相关潜在炎症可能是关键病因，但食管MC的发病机制尚未完全明确，可能是多种病因共同作用的结果。同样，更多病例报告可能会增进我们对这种罕见疾病的临床意义及治疗的理解。
