Annular lichen planus involving the esophagus: a rare diagnosis

A 49-year-old woman presented with a 2-year history of a sore mouth, annular, atrophic patches, and chronic ulcerative vulvovaginitis. For 6 years, she had suffered from dysphagia. to solids which was increasing in severity. There was no past history of heartburn or other symptoms of esophageal reflux. Mucocutaneous examination showed white erosive patches on the buccal mucosa, cicatricial alopecia, dystrophic nails, and annular atrophic pigmented plaques localized on the trunk (Fig. 1). Genital examination showed atrophic and sclerotic vulvovaginal lesions with synechia. Cutaneous biopsy showed an atrophic epidermis, a dense lymphocytic infiltrate in the upper dermis with degeneration of the basal epithelium, and Civatte bodies. Serologic tests for hepatitis B and C were negative. A diagnosis of cutaneous annular lichen planus with nail, scalp, oral, and genital involvement was made. Fiberoptic endoscopy, undertaken 6 years previously, revealed erosive and two ulcerative lesions in the esophagus, extending to 20 cm from the incisors. Biopsy from the affected upper esophagus revealed nonspecific inflammatory changes with lymphocytic infiltration. A barium swallow revealed a 5-mm, regular and inflammatory stricture in the upper esophagus (Fig.,2). A diagnosis of stenosing lichen planus of the esophagus was made 6 years after the first symptoms of dysphagia. Treatment was started with oral prednisolone, 50 mg daily.