Eosinophilic esophagitis masquerading as steakhouse syndrome: A case report

Abstract

Background

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated esophageal disorder marked by eosinophil infiltration and symptoms that frequently resemble gastroesophageal reflux disease (GERD). It is usually accompanied by atopic conditions such as asthma, eczema, allergic rhinitis, and food allergies. Steakhouse syndrome is characterized by acute esophageal food impaction, which is more frequent in older people and can be caused by various underlying diseases, including EoE. Accurate diagnosis and management of EoE are critical for symptom relief and to prevent complications.

Case Presentation

A 27-year-old man with lactose, nut, and cabbage allergies and a history of recurrent food impactions complained of chest pain after eating meat. Initial examinations, including chest and spine X-rays and laboratory testing, were normal, with no elevated eosinophils in the CBC differential. An emergency gastroscopy revealed a stenotic esophagus with rings and furrows, and food residue, favoring steakhouse syndrome. Biopsies revealed more than 15 eosinophils per high-powered field, indicating EoE, while malignancy was ruled out. Omeprazole, fluticasone, and a six-food elimination diet were used for treatment. A follow-up endoscopy after one month revealed both endoscopic and histologic remission.

Conclusion

This case emphasizes the significance of identifying EoE as a possible cause of recurring dietary impacts that manifest as steakhouse syndrome. A thorough examination and correct diagnosis are essential for effective treatment. The patient’s successful resolution emphasizes the importance of clinical vigilance and comprehensive treatment strategies for esophageal disorders. Further research is warranted to improve diagnostic and therapeutic approaches for EoE.