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| CASE REPORT |
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| Year : 2021 | Volume
: 15
| Issue : 1 | Page : 44-46 |
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Plummer–Vinson syndrome
Abhishek Deepak1, Atul Kaushik2, Shahzad Anwar2, Kshitij Chauhan2
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 Submission | 21-Jan-2022 |
| Date of Decision | 24-Jan-2022 |
| Date of Acceptance | 26-Jan-2022 |
| Date of Web Publication | 13-Apr-2022 |
Correspondence Address:
Dr. Atul Kaushik
Department of General Medicine, Sharda Hospital, Knowledge Park-3, Greater Noida - 201 308, Uttar Pradesh
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/upjimi.upjimi_2_22
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 |
| Introduction | |  |
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 | | |
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 2: (a) Barium swallow anteroposterior view. (b) Barium swallow lateral view. (c and d) Upper gastrointestinal endoscopy
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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 | | |
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 | | |
| 1. | Novacek G. Plummer-Vinson syndrome. Orphanet J Rare Dis 2006;1:36.  |
| 2. | Hoffman RM, Jaffe PE. Plummer-Vinson syndrome. A case report and literature review. Arch Intern Med 1995;155:2008-11. |
| 3. | Chung S, Roberts-Thomson IC. Gastrointestinal: Upper oesophageal web. J Gastroenterol Hepatol 1999;14:611. |
| 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. |
| 5. | Sanfrancesco J, Jones JS, Hansel DE. Diagnostically challenging cases: What are atypia and dysplasia? Urol Clin North Am 2013;40:281-93. |
| 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. |
| 7. | Okamura H, Tsutsumi S, Inaki S, Mori T. Esophageal web in Plummer-Vinson syndrome. Laryngoscope 1988;98:994-8. |
| 8. | Chisholm M. The association between webs, iron and post-cricoid carcinoma. Postgrad Med J 1974;50:215-9. |
| 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. |
[Figure 1], [Figure 2]
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