Baig Sher N, Rehman Sadia, Daniel Mina, Deshpande Vrushak, Abdelsayed George, Gonzalez Manuel
Department of Internal Medicine, Richmond University Medical Center, Staten Island, NY.
Division of Gastroenterology, Department of Internal Medicine, Richmond University Medical Center, Staten Island, NY.
ACG Case Rep J. 2020 Feb 26;7(2):e00321. doi: 10.14309/crj.0000000000000321. eCollection 2020 Feb.
A 79-year-old African American woman presented with acute hematemesis after progressive dysphagia for 6 weeks and 12-pound weight loss. She had no predisposing immunocompromising comorbidity such as the human immunodeficiency virus or active malignancy. Computed tomography showed air-fluid levels within the esophagus with partial obstruction. Upper endoscopy revealed a 1-cm mass lesion in the midthoracic esophagus, and biopsy results surprisingly showed esophageal actinomycosis. The patient's symptoms resolved on antimicrobial therapy at a one-month follow-up, and the lesion was not seen on repeat endoscopy with biopsy at 3 months. We believe that inhaled corticosteroids for chronic obstructive pulmonary disease may have created the growth milieu by impairing local defenses. Correct inhaler technique, avoiding swallowing the water after mouth rinsing, and a spacer device are recommended to reduce esophageal corticosteroid exposure.
一名79岁的非裔美国女性，在进行性吞咽困难6周并体重减轻12磅后出现急性呕血。她没有诸如人类免疫缺陷病毒或活动性恶性肿瘤等导致免疫功能低下的合并症。计算机断层扫描显示食管内有气液平面伴部分梗阻。上消化道内镜检查发现胸段食管中段有一个1厘米的肿块病变，活检结果令人惊讶地显示为食管放线菌病。患者在1个月的随访中经抗菌治疗后症状缓解，3个月时重复内镜检查及活检未见病变。我们认为，用于慢性阻塞性肺疾病的吸入性糖皮质激素可能通过损害局部防御机制而营造了生长环境。建议采用正确的吸入器技术、避免漱口后吞咽水以及使用间隔装置，以减少食管糖皮质激素暴露。
