Spontaneous esophageal perforation in eosinophilic esophagitis in children.

intermittent solid food dysphagia and blockage was admitted because of chest pain, pyrosis, and fever (38.3 8C). The only medication she was on at the time of our evaluation was the inhaler Salbuta− mol−sulfate, which she used as needed. Symptoms started a few hours after a food blockage episode. Physical examina− tion was normal, except for tachycardia (135 bpm). Laboratory results showed: leukocytosis (17300/mm3), 11.59 ” 109 neutrophils, a high C−reactive protein (180 mg/l), and erythrocyte sedimenta− tion rate of 74 mm/h. Chest radiograph was normal. Chest com− puted tomography scan (l" Fig. 1 a) showed a retroesophageal perforation, with periesophageal fluid collection. Ini− tial treatment consisted of fasting, intra− venous antibiotics (ceftriaxone 1.5 g/d, metronidazole 300 mg t. i.d, gentamicin 90 mg/d), and proton pump inhibitor (30 mg/d), with good evolution. Upper endoscopy (l" Fig. 1 b) 2 months later showed an upper esophageal resistance to the tube passage without stenosis, and normal mucosa. Biopsies demonstrated very many intraepithelial eosinophil ag− gregates > 20 eos/HPF (l" Fig. 1 c). Eosinophilic esophagitis is characterized by esophageal and/or upper gastrointesti− nal tract symptoms in association with an esophageal mucosal biopsy containing 3 15 intraepithelial eos/HPF in one or more biopsy specimen, without patho− logic gastroesophageal reflux disease (GERD) [1]. Eosinophilic esophagitis is a rare chronic inflammatory disease, with a varied clinical and endoscopic spec− trum. Some age−related differences were noted between symptoms in children and adults. In children, feeding refusal or intolerance, GERD−like symptoms, eme− sis, abdominal pain, dysphagia, food im− paction, chest pain, and diarrhea have been described [1]. In adults, intermittent dysphagia and food impaction are more common [1]. Transmural inflammation has been reported in eosinophilic esopha− gitis. It significantly increases the risk of perforation. Mucosal laceration and transmural perforation have been report− ed after endoscopy or dilation in eosino− philic esophagitis [2, 3]. Spontaneous esophageal perforation was recently reported in three adults, asso− ciated with eosinophilic esophagitis [2± 4]. Until now, no reports of this unusual association and presentation have been reported in children, extending the clini− cal spectrum of eosinophilic esophagitis in this population.