Idiopathic eosinophilic oesophagitis : atypical presentation of a rare disease

A 72 year-old man presented severe dysphagia and weight loss of recent onset. Repeated oesophageal endoscopy and biopsies with macroforceps were normal. oesophageal manometry dis- closed features compatible with achalasia. oesophageal EUS endoscopy localized an infiltrating process between muscular layers of the oesophageal wall and CT scan delimited a circular thickening in the inferior part of the oesophagus. Because of severe clinical presentation mimicking a possible oesophageal neoplasm like a lymphoma, partial oesophagectomy was performed and revealed eosinophilic oesophagitis. This unusual presentation emphasizes that idiopathic eosinophilic oesophagitis must be pro- posed in the differential diagnosis of dysphagia, even in old patient without apparent oesophageal lesion at endoscopy. (Acta gastroen- terol. belg., 2004, 67, 232-235).