International Journal of Medical Case Reports

Eosinophilic Esophagitis with Long-standing Dysphagia

Yohannes Birhanu, Yonas Bekuretsion, Henok Seife, Bethelhem Zerfu

Abstract:
Eosinophilic esophagitis (EoE) is a chronic, immune-mediated inflammatory condition that primarily affects the esophagus, characterized by the infiltration of eosinophils into the esophageal mucosa. This condition leads to symptoms of esophageal dysfunction, including dysphagia (difficulty swallowing), food impaction, and substernal pain. EoE is commonly associated with other atopic diseases such as asthma, allergic rhinitis, and eczema, and it predominantly affects young men with a history of atopy. Although it can occur in both children and adults, EoE is often underdiagnosed due to its subtle or nonspecific symptoms and its overlap with other gastrointestinal disorders. Rarely, EoE can present with severe complications, such as spontaneous esophageal perforation, known as Boerhaave’s syndrome, which is a life-threatening emergency. A typical diagnostic approach for EoE includes esophageal biopsies, which reveal significant eosinophilic infiltration, and endoscopic findings that may show structural changes such as strictures or rings in the esophagus. In some cases, the strictures can be severe, leading to difficulty swallowing and even food impaction. We present the case of a 36-year-old man from Addis Ababa, Ethiopia, who had been experiencing persistent substernal pain and dysphagia for eight years. His symptoms gradually worsened over time, prompting further investigation. Endoscopic examination revealed a severe lower esophageal stricture located approximately 35 cm from the incisors, and esophageal biopsies confirmed the presence of significant eosinophilic infiltration, consistent with a diagnosis of EoE. This case highlights the importance of considering EoE in patients with chronic dysphagia and substernal pain, especially those with a history of atopic conditions, and emphasizes the need for timely diagnosis and management to prevent complications.

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International Journal of Surgery Case Reports

Metachronous breast and rectal cancer: A clinical case report and review

Henok Seife, Yohannes Birhanu, Wondemagegnhu Tigeneh, Bethelhem Zerfu

Abstract:
Multiple primary cancers in one person are uncommon, yet their incidence is rising due to advancements in cancer treatment, enhanced screening, and increased life expectancy. This case report details the presentation, diagnosis, and management of a 56-year-old female patient diagnosed with metachronous right breast ductal carcinoma and adenocarcinoma of the rectum.

Case presentation:
We present the case of a 56-year-old nulliparous, postmenopausal Ethiopian woman initially diagnosed with right breast ductal carcinoma (cT2 N3c M1, ER/PR positive, Her-2 negative). She received palliative chemotherapy and bisphosphonate therapy, followed by hormonal therapy. Approximately two years after her initial breast cancer diagnosis and while on follow-up, she developed rectal bleeding and tenesmus of 1–2 months' duration. Subsequent MRI revealed a rectal mass, and biopsy confirmed adenocarcinoma of the rectum. Given the locally advanced nature of the rectal disease, neoadjuvant chemotherapy was advised. The patient's subsequent course was complicated by chemotherapy-induced toxicity, highlighting the challenges in managing such complex cases.

Discussion:
The co-occurrence of metachronous breast and rectal cancers is rare and poses significant diagnostic and therapeutic challenges. This case underscores the critical role of vigilant surveillance and a highly personalized, multidisciplinary treatment approach for patients with a history of malignancy. Immunohistochemistry, combined with a detailed medical history, is essential for definitive diagnosis and differentiating primary tumor origins. The development of metachronous cancers raises concerns about shared genetic, environmental, and therapeutic factors, necessitating a holistic view of patient care.

Conclusion:
The diagnosis and treatment of metachronous malignancies, particularly involving the breast and rectum, are inherently complex. Optimal patient outcomes necessitate a comprehensive, coordinated, and individualized approach, emphasizing the importance of long-term surveillance and adaptable management strategies.

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