Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Feb 16, 2015; 7(2): 154-158
Published online Feb 16, 2015. doi: 10.4253/wjge.v7.i2.154
Rare case of dysphagia, skin blistering, missing nails in a young boy
Jasbir Makker, Bharat Bajantri, Prospere Remy
Jasbir Makker, Bharat Bajantri, Prospere Remy, Division of Gastroenterology, Department of Medicine, Bronx Lebanon Hospital Center, Albert Einstein College of Medicine of Yeshiva University, New York, NY 10457, United States
Author contributions: Makker J and Bajantri B contributed equally in writing the manuscript; Remy P edited and approved the final version of manuscript.
Ethics approval: Institutional Review Board waiver was obtained.
Informed consent: Informed written consent was obtained prior to writing this case report.
Conflict-of-interest: Authors have no conflicts of interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Jasbir Makker, Gastroenterology Fellow, Division of Gastroenterology, Department of Medicine, Bronx Lebanon Hospital Center, Albert Einstein College of Medicine of Yeshiva University, 1650 Grand Concourse Bronx, New York, NY 10457, United States.
Telephone: +1-347-3228242 Fax: +1-718-5185111
Received: October 2, 2014
Peer-review started: October 12, 2014
First decision: December 12, 2014
Revised: December 22, 2014
Accepted: January 9, 2015
Article in press: January 12, 2015
Published online: February 16, 2015

Epidermolysis bullosa is a group of genetic disorders with an autosomal dominant or an autosomal recessive mode of inheritance and more than 300 mutations. The disorder is characterized by blistering mucocutaneous lesions and has several varying phenotypes due to anchoring defect between the epidermis and dermis. The variation in phenotypic expression depends on the involved structural protein that mediates cell adherence between different layers of the skin. Epidermolysis bullosa can also involve extra-cutaneous sites including eye, nose, ear, upper airway, genitourinary tract and gastrointestinal tract. The most prominent feature of the gastrointestinal tract involvement is development of esophageal stricture. The stricture results from recurrent esophageal mucosal blistering with consequent scarring and most commonly involves the upper esophagus. Here we present a case of a young boy with dominant subtype of dystrophic epidermolysis bullosa who presented with dysphagia, extensive skin blistering and missing nails. Management of an esophageal stricture eventually requires dilatation of the stricture or placement of a gastrostomy tube to keep up with the nutritional requirements. Gastrostomy tube also provides access for esophageal stricture dilatation in cases where antegrade approach through the mouth has failed.

Keywords: Epidermolysis bullosa, Dysphagia, Esophageal stenosis, Gastrostomy, Blistering

Core tip: Epidermolysis bullosa is a genetic disorder with four main types. The most prominent feature of the disease is extensive skin blisters. Extra-cutaneous manifestations like dysphagia vary among different subtypes. Recessive type of dystrophic epidermolysis bullosa is the subtype most commonly associated with esophageal strictures. Treatment of dysphagia secondary to esophageal stricture involves changing diet texture, dilatation of the stricture and placement of a gastrostomy tube.