On Examination the patient is a middle aged lady looking pale and a bit anxious. On general physical the following features were seen in the nails and the tongue.
On lab work There was microcytic hypochromic anemia and a barium swallow revealed esophageal webs on the anterior esophageal wall.
What is the most probable diagnosis?
.
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Plummer Vinson Syndrome (triad of difficulty swallowing, iron deficiency anemia & esophageal webs)
Case Discussion:
Plummer vinson syndrome is a condition that most commonly occurs in patients with long standing iron deficiency anemia. The exact cause is unknown but genetic factors and underlying nutritional deficiencies may play a role. It is more common in woman. Sometime patients may go on to develop esophageal cancer.
Clinical features: may include:
- Difficulty in swallowing
- Painful swallowing
- Weakness
- Fatigue
- Atrophic glossitis
- Angular stomatitis.
Diagnosis : is clinical based on the triad of difficulty in swallowing, iron deficiency anemia and esophageal webs. Following workup is done:
- Complete blood count with peripheral smear.
- Iron studies ( including serum ferritin and TIBC)
- Barium esophagogram
- Video fluroscopy
Treatment; includes iron supplements and widening of the web tissue during upper endoscopy to help swallowing the food.
Differential Diagnosis:
- Esophageal cancer
- Isolated esophageal webs and rings
- Iron deficiency anemia
- Hypopharangeal cancer
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