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Dicyclomine-Induced Esophagitis Dissecans Superficialis


 
 
 Esophagitis dissecans superficialis (EDS) is a rare benign condition of the esophagus, characterized by desquamation of superficial epithelium of the esophageal lining. Etiology is uncertain, considered idiopathic in most cases. EDS can be associated with medications, hot beverages, chemical irritants, celiac disease and skin bullous disorders. It has a predilection for the distal and/or middle esophagus.
 
 
 
 We report a case of a 25-year-old otherwise healthy female with mild gastrointestinal symptoms over 3 years. Her symptoms had worsened over a period of 2-3 weeks, and she complained of lower abdominal cramping associated with constipation. No rectal bleeding or melena was reported. Labs including complete blood count and comprehensive metabolic panel were within normal range values. A presumptive diagnosis of irritable bowel syndrome was made by gastroenterologist. Antispasmodic drug, Dicyclomine 10 mg capsule (a blue capsule), was prescribed. After 4 weeks, a scheduled esophagogastroduodenoscopy revealed patchy plaque-like mucosal changes, characterized by blue discoloration, in the upper third of esophagus. Microscopically, biopsy showed strips of squamous mucosa with a thick layer of parakeratosis, basal cell hyperplasia and foci of minimal inflammation. There were multiple transverse splits at different levels in the parakeratotic layer. A pathologic diagnosis of EDS was established. A further clinical investigation demonstrated that the patient was swallowing medication without water.
 
 
 
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 In conclusion, we present the first case of Dicyclomine-Induced EDS secondary to an irritant effect of waterless medication ingestion. Recognition of this rare entity and clinical correlation are important as it can pose a diagnostic challenge to pathologists and clinicians.
