• Users Online: 130
  • Print this page
  • Email this page


 
 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 15  |  Issue : 1  |  Page : 44-46

Plummer–Vinson syndrome


1 Department of Gastroenterology, Sharda Hospital, SMS and R, Greater Noida, Uttar Pradesh, India
2 Department of General Medicine, Sharda Hospital, SMS and R, Greater Noida, Uttar Pradesh, India

Date of Submission21-Jan-2022
Date of Decision24-Jan-2022
Date of Acceptance26-Jan-2022
Date of Web Publication13-Apr-2022

Correspondence Address:
Dr. Atul Kaushik
Department of General Medicine, Sharda Hospital, Knowledge Park-3, Greater Noida - 201 308, Uttar Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/upjimi.upjimi_2_22

Rights and Permissions
  Abstract 


Plummer–Vinson syndrome (PVS) is characterized by a triad of postcricoid dysphagia, upper esophageal webs, and iron deficiency anemia, mostly affecting middle-aged females. A 30-year-old female patient presented to the gastroenterology outpatient department with complaints of dysphagia for solid foods for 1 year, which increased over the last 4 weeks. She had iron deficiency anemia. Barium swallow revealed a single thin esophageal web at the level of C4–5 vertebrae. Upper gastrointestinal endoscopy confirmed this. The patient was diagnosed with PVS. PVS is known to be associated with esophageal or pharyngeal cancers such as squamous cell carcinoma. Thus, we recommend early diagnosis of PVS and close follow-up of these patients.

Keywords: Dysphagia, iron deficiency anemia, Plummer–Vinson syndrome


How to cite this article:
Deepak A, Kaushik A, Anwar S, Chauhan K. Plummer–Vinson syndrome. J Intern Med India 2021;15:44-6

How to cite this URL:
Deepak A, Kaushik A, Anwar S, Chauhan K. Plummer–Vinson syndrome. J Intern Med India [serial online] 2021 [cited 2023 Mar 24];15:44-6. Available from: http://www.upjimi.com/text.asp?2021/15/1/44/343027




  Introduction Top


Plummer–Vinson syndrome (PVS) is characterized by a triad of postcricoid dysphagia, upper esophageal webs, and iron deficiency anemia, affecting middle-aged females.[1]

It usually presents with painless, progressive dysphagia limited to solid with or without symptoms of anemia such as weakness, pallor, fatigue, and tachycardia.[1],[2]

Esophageal webs can be detected by barium swallow X-ray, but the best way for demonstration is the videofluoroscopy.[2],[3]

On microscopic histopathological analysis, PVS presents with epithelial atrophy, chronic submucosal inflammation, and epithelial atypia or dysplasia in advanced cases.[4],[5] Chronic irritation of the esophagus may predispose to an increased risk of developing esophageal webs or strictures. Common complications of PVS include hypopharyngeal cancer, esophageal cancer, and oral cancer.[6]

Here, we present a middle-aged female with PVS who was treated with oral hematinics..


  Case Report Top


A 30-year-old female patient presented to the gastroenterology outpatient department in our hospital with complaints of dysphagia for solid foods for 1 year, which increased over the last 4 weeks. There was no difficulty in swallowing a liquid diet.

There was no history of nausea, vomiting, retching, diarrhea, weight loss, shortness of breath, chest pain, loss of consciousness, abnormal body movement, or bowel or bladder involvement. The patient had no comorbidities such as diabetes mellitus and thyroid dysfunction. There was no family history of cancer.

On examination, the patient was conscious, alert, and oriented to time, place, and person. She had pulse of 86/min, blood pressure of 122/70 mmHg, respiratory rate of 18/min, SpO2 of 98% at ambient air, and temperature of 97.3°F. General physical examination was unremarkable except for the presence of pallor. The systemic examination was unremarkable.

NCCT neck was unremarkable. The initial laboratory investigations done are shown in [Figure 1] which confirmed moderate anemia of microcytic and hypochromic nature on GBP. On further evaluation, it was found to be Iron deficiency anemia. Chest X-ray posteroanterior view was within normal limits. Barium swallow revealed a single thin esophageal web at level of C4–5 vertebrae in both anteroposterior and lateral views and videography, as shown in [Figure 2]a and [Figure 2]b. Upper gastrointestinal endoscopy confirmed this upper esophageal web which narrowed the lumen, thus preventing passage of both adult and neonatal endoscope as shown in [Figure 2]c and [Figure 2]d.
Figure 1: Laboratory profile of the patient

Click here to view
Figure 2: (a) Barium swallow anteroposterior view. (b) Barium swallow lateral view. (c and d) Upper gastrointestinal endoscopy

Click here to view


The patient was diagnosed as a case of PVS. The patient was managed with oral hematinics such as ferric ammonium citrate, albendazole (400 mg stat), folic acid, and Vitamin C (500 mg OD). Her dysphagia improved significantly. On follow-up at 4th week and 8th week, she was asymptomatic, and her hemoglobin increased to 9.7 mg/dl.


  Discussion Top


In this case, the patient was suffering from dysphagia for solids for over a year, which when evaluated lead to the discovery of underlying iron deficiency anemia and postcricoid web. This completed the triad of PVS.

Although the pathogenesis of PVS remains largely unknown, the most probable mechanism of PVS is iron deficiency, leading to rapid loss of iron-dependent enzymes due to its high cell turnover. Loss of these enzymes causes mucosal degenerations, atrophic changes, and web formation, which are associated with dysphagia.[7],[8]

Treatment of iron deficiency anemia with/without dilatation of postcricoid web by endoscopic balloon or Savary–Gillard dilators after anesthetizing throat mucosa remains the mainstream treatment.[6] There are cases been reported in which the use of only iron supplements leads to improvement in dysphagia.[9] Here, we gave a trial of oral iron supplements for 8 weeks after which there was significant improvement in her dysphagia.

PVS is known to be associated with esophageal or pharyngeal cancers such as squamous cell carcinoma.[1] Thus, we recommend early diagnosis of PVS and close follow-up of these patients.

Consent to participate

Informed consent was given. Also, the individual rights are not infringed, and the identity of the study subject is not disclosed. Complete anonymity is maintained.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Novacek G. Plummer-Vinson syndrome. Orphanet J Rare Dis 2006;1:36.  Back to cited text no. 1
    
2.
Hoffman RM, Jaffe PE. Plummer-Vinson syndrome. A case report and literature review. Arch Intern Med 1995;155:2008-11.  Back to cited text no. 2
    
3.
Chung S, Roberts-Thomson IC. Gastrointestinal: Upper oesophageal web. J Gastroenterol Hepatol 1999;14:611.  Back to cited text no. 3
    
4.
Field Z, Russin M, Kropf J, Olivier M, Ge L, Galili Y, et al. Plummer-Vinson syndrome and heart failure: An unusual association in an African American woman. Am J Case Rep 2019;20:1264-7.  Back to cited text no. 4
    
5.
Sanfrancesco J, Jones JS, Hansel DE. Diagnostically challenging cases: What are atypia and dysplasia? Urol Clin North Am 2013;40:281-93.  Back to cited text no. 5
    
6.
Goel A, Bakshi SS, Soni N, Chhavi N. Iron deficiency anemia and Plummer-Vinson syndrome: Current insights. J Blood Med 2017;8:175-84.  Back to cited text no. 6
    
7.
Okamura H, Tsutsumi S, Inaki S, Mori T. Esophageal web in Plummer-Vinson syndrome. Laryngoscope 1988;98:994-8.  Back to cited text no. 7
    
8.
Chisholm M. The association between webs, iron and post-cricoid carcinoma. Postgrad Med J 1974;50:215-9.  Back to cited text no. 8
    
9.
Tahara T, Shibata T, Okubo M, Yoshioka D, Ishizuka T, Sumi K, et al. A case of Plummer-Vinson syndrome showing rapid improvement of Dysphagia and esophageal web after two weeks of iron therapy. Case Rep Gastroenterol 2014;8:211-5.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Case Report
Discussion
References
Article Figures

 Article Access Statistics
    Viewed1456    
    Printed262    
    Emailed0    
    PDF Downloaded116    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]