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Program

Internal Medicine

Training Level

Resident PGY 1

Institution

Henry Ford Hospital

Abstract

A 37-year-old African American woman with no past medical history presented to the Emergency Department with a chief complaint of abdominal pain. She also reported associated fatigue and dysphagia. Over the past two months, she reported 40 Lbs. unintentional weight loss and decrease appetite. Her dysphagia primarily to solids, which also had been worsening over the past few weeks. She had no history of similar symptoms in the past. She was not on any medications. On admission, vital signs were stable. In the Emergency Department,. Hemoglobin on admission was 3.3 g/dL [11.9–15.1 g/dL] with a mean corpuscular volume of 61.1. Her serum iron on admission was 10 ug/dL [60–140 ug/dL], iron saturation was 2% [15–50%], and ferritin was 1.0 ng/mL [11.0–307 ng/mL]. Upon further questioning, the patient stated that she did not describe menorrhagia. She denied hematemesis, hematochezia, or melena. She was transfused with 3 units of packed red blood cells and was started on 1000 mg of IV iron dextran complex infusions. Gastroenterology was consulted, and the patient underwent esophagogastroduodenoscopy (EGD) and colonoscopy. Colonoscopy showed erythematous and edematous mucosa in the terminal ileum which was Biopsied. The EGD revealed a few intrinsic stenoses in the upper esophagus which were successfully dilated with savary. A pathology exam of the terminal ileum showed well differentiated neuroendocrine tumor. Given the clinical, laboratory, and endoscopic (as shown below) Esophageal web located in the upper esophagus. a diagnosis of Plummer-Vinson syndrome was made. Her dysphagia improved over the three days in the hospital after iron infusions and blood transfusions, and she was able to tolerate a regular diet. Approximately 2 months after her discharge, a follow-up phone call was made to the patient. She stated that she had been compliant with all her medications and her dysphagia had resolved. At the time of the phone call, she was tolerating a regular diet without any dietary restrictions.

Presentation Date

5-2020

Plummer-Vinson Syndrome

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