Ulcerative Esophagitis With Marked Eosinophilic Infiltration and Fluorodeoxyglucose–Positron Emission Tomography Positivity Requiring Differentiation From Esophagogastric Junction Carcinoma

Esophagitis with marked eosinophilic infiltration, including eosinophilic esophagitis (EoE), can rarely present with ulceration or stricture. We report a rare case of positron emission tomography–positive esophagitis with marked eosinophilic infiltration accompanied by ulceration and stricture, requiring differentiation from esophagogastric junction carcinoma. A 50‐year‐old man with no history of allergies underwent computed tomography, which revealed para‐esophageal lymphadenopathy and circumferential thickening of the distal esophagus. Endoscopy showed an ulcerated stricture with an iodine‐unstained area. Positron emission tomography demonstrated fluorodeoxyglucose uptake at the lesion site. Multiple endoscopic biopsies (11 specimens) were negative for malignancy but revealed 70 eosinophils per high‐power field, fulfilling the diagnostic criteria for EoE. Hiatal hernia was also observed, suggesting the possibility of concomitant reflux esophagitis. Significant dysphagia persisted due to the severe stricture. Therefore, endoscopic bougie dilation was carefully performed under general anesthesia. After 8 weeks of proton pump inhibitor therapy, mucosal healing was confirmed, and topical steroids were initiated for persistent eosinophilic infiltration. This case highlights that esophagitis with marked eosinophilic infiltration accompanied by ulceration and stricture may require differentiation from cancer.