Iron Deficiency as Cause of Dysphagia and Burning Mouth (Plummer-Vinson or Kelly-Patterson Syndrome): a Case Report.

The clinical presentation of iron deficiency can be very heterogeneous, including various oral and other mucosal problems. Here, in this case, we report the patient with burning mouth and dysphagia symptoms where iron deficiency was found to be the underlying cause after several months of investigations. This clinical syndrome is called Plummer-Vinson syndrome. It is sporadic with an incidence less than 0.1% of patients suffering from iron deficiency anemia.

[Mucous diaphragm of the cervical esophagus. Apropos of 38 cases discovered during upper endoscopy at the General Hospital of Dakar. Relationship with the Kelly-Paterson or the Plummer-Vinson syndrome]. / Diaphragme muqueux de l'oesophage cervical a propos de 38 cas découverts au cours d'endoscopies hautes à l'Hôpital Principal de Dakar. Relation avec le syndrome de Kelly-Paterson ou de Plummer-Vinson.

At the occasion of 15,000 high endoscopies performed during the past 5 years at the general Hospital of Dakar (Senegal) 38 mucous diaphragms of cervical esophagus were discovered. 36 patients are Black Senegalese; 29 females and 9 males with a mean age of 37. Dysphagia was present 29 times and anemia 22 times. Endoscopies diagnosis is easy, putting into light a mucous diaphragm at the level or immediately below Killian mouth. 18 of these cases have been classified as Kelly-Paterson syndrome. Performed in 30 patients, the treatment consists in breaking down the mucous diaphragm with an endoscope. It is difficult to keep on endoscopic monitoring, although it is essential because the risk of cancerisation.

[Mucoid webs of the cervical esophagus. Apropos of 38 cases discovered during upper endoscopy at the Hôpital Principal of Dakar. Relationship to Plummer-Vinson syndrome]. / Diaphragmes muqueux de l'oesophage cervical. A propos de 38 cas découverts au cours d'endoscopies hautes à l'Hôpital Principal de Dakar. Relation avec le syndrome de Plummer-Vinson.

Thirty-eight cervical esophageal mucous diaphragms were discovered in the course of 15,000 high endoscopies carried out over the past 5 years at Dakar General Hospital. Thirty-six of the sufferers were Black Senegalese. The 29 women and 9 men had an average age of 37 years. Dysphagia was diagnosed 29 times, and anemia 22 times. Endoscopic diagnosis readily shows the mucous diaphragm at the level of, or immediately below, KILLIAN's mouth. PLUMMER-VINSON's syndrome affected 16 of these patients. Treatment consists in collapsing the mucous diaphragm by putting the endoscope through it: this happened to 30 of the patients. Endoscopic surveillance is indispensable because of the risk of cancer, but is difficult to perform.

Síndrome de Plummer-Vinson: reporte de caso y revisión de literatura / Plummer-Vinson Syndrome: case report and review of literature

Presentamos a una mujer de 39 años que acude a nuestro hospital por disnea de esfuerzo, adinamia y cansancio progresivo desde hace 8 meses. Antecedente quirúrgico de miomectomia por menometrorragias frecuentes. Niega ser vegetariana. Régimen catamenial: 3-5 días cada mes. Hace 2 meses se añade ôardorõ en lengua al comer. Nota uñas quebradizas. Toleraba alimentos blandos. Al examen físico había moderada palidez; las uñas eran muy delgadas, frágiles y algo cóncavas. En la boca se encontró estomatitis angular, lengua depapilada y glositis. El diagnóstico clínico era síndrome anémico y disfagia. Exámenes auxiliares: Hb: 7.0g/dL; VCM: 57.42fL; HCM: 15.82pg; leucocitos: 4,980; reticulocitos: 2.18%, índice reticulocitario: 0.1%, hierro sérico: 21ug/dl, transferrina (TIBC): 286, saturación de transferrina: 7%, ferritina sérica: 27ng/ml. La lámina periférica demostró anisocitosis, hipocromía y microcitosis. Thevenon en heces negativo. Ecografía abdominal: mioma uterino. La radiografía esofágica con bario demostró una imagen lineal por defecto de relleno de 2 mm a altura entre vértebras C4 y C5 en vista anteroposterior y lateral; se extendía a cara anterior y reducía la luz esofágica en 60%. Durante la endoscopía, evidenciamos una membrana fibrosa estenosante en la región cricofaríngea. Multiples dilataciones fueron realizadas progresivamente mediante una guía con bujías dilatadoras Savary-Gilliard hasta 14 mm, mejorando la disfagia. Recibió terapia transfusional y hierro parenteral. Salió de alta con sulfato ferroso y ácido fólico. El síndrome de Plummer-Vinson, Paterson-Brown-Kelly o disfagia sideropénica es definido por disfagia, anemia ferropénica y membrana esofágica alta. El síndrome es descrito como muy raro.

A 39-year-old woman was admitted to our hospital with an eight-month history of dyspnea on exertion, weakness and increasing fatigue. She reported repeated episodes of menome trorrhsgis snd underwent a myomectomy. She is not a vegetarian. Her menstrual bleeding: 3-5 days per month. Two months ago, she complained of burning sensation of the tonge upon swallowing food and noted brittle nails. She tolerated soft foods. On physical examination, she was pale; her nails were very thin, fragile and somewhat concave. Her oral examination showed angular stomatitis, depapillated togue and glossitis. The clinical diagnosis was anemia and dysphagia. Laboratory tests were: Hb: 7.0g/dL, MCV: 57.42fL, MCH: 15.82 pg; leukocytes:4,980; reticulocytes:2.18%, reticulocyte index:0.1%, serum iron:21ug/dl, total iron binding capacity (TIBC):286, transferrin saturation: 7% and serum ferritin: 27ng/ml. The peripheral blood smear showed anisocytosis and hypochromic microcytic cells. Thevenon test was negative. Abdominal ultrasound: uterine myoma. A barium swallow X-ray showed a 2-mm linear filling defect between the 4th and 5th cervical vertebrae in the anteroposterior and lateral view; it protruded from the anterior wall and reduced esophageal lumen by 60%. In the endoscopy, we found a fibrous web in the cricopharyngeal area. Serial dilatations were performed over a guidewire using Savary-Gilliard dilators with diameter up to 14 mm, improving dysphagia. She was treated with transfusional therapy and parenteral iron. She was discharged with ferrous sulfate and folic acid. The Plummer-Vinson syndrome, Paterson-Brown-Kelly or sideropenic dysphagia is characterized by dysphagia, iron-deficiency anemia and upper esophaegal web. The syndrome is described as very rare.

[Oral leukoplakias. I. Classification, differential diagnosis, etiological conditions for neoplastic transformation, prognosis]. / Orale Leukoplakien I. Klassifikation, Differentialdiagnose, ätiologische Bedingungen der Kanzerisierung, Prognose.

Leucoplakia is due to abnormal keratinization of squamous epithelial mucosa and constitutes a pattern of reaction of the oral mucosa which is typical for the tissue but unspecific for any stimulus. Because of its numerous causes leucoplakia cannot be defined as a pathologic entity. There is leucoplakia in the narrow sense and leucoplakia in the broad sense; the first should be regarded as a polyetiologic symptom but not as a disease in itself. Leucoplakias in the broad sense comprise those caused by well defined disorders. A classification of oral leucoplakias must include both categories, for differential diagnostic reasons. Therefore a classification of leucoplakias in the broad sense (hereditary 1., endogenous-irritative 1.) and leucoplakias in the narrow sense (exogenous-irritative 1., precancerous 1.) is proposed. The latter category is largely identical with the WHO definition of leucoplakia. The most important clinical and histological grounds on which this classification is based are explained. The precancerous lesions and the present knowledge of stomatology and oral pathology are particularly taken into consideration.

Síndrome de Plummer-Vinson: relato de dois casos / Plummer-Vinson syndrome: report of two cases

As membranas esofágicas, quando localizadas no esôfago cervical e associadas a quadro de anemia ferropriva, alterações na mucosa bucal, faríngea e gástrica, constituem a síndrome de Plummer-Vinson. O objetivo deste trabalho é apresentar os aspectos clínicos de dois pacientes do sexo feminino, com 51 e 66 anos de idade, com disfagia havia seis e sete anos, anemia, glossite e coiloníquia. O exame físico em ambos mostrou desnutrição e anemia. Estudos radiológicos e endoscópicos demonstraram estreitamento no esôfago proximal. O estudo manométrico: aperistalse com contrações de baixa amplitude em uma paciente e exame normal na outra. Dilatações foram realizadas nas pacientes com sondas de Savary-Guillard, sendo que uma necessitou de nova dilatação com oliva de Eder-Puestow. Esses resultados dão suporte ao conceito de que a dilatação endoscópica é a melhor opção para o tratamento da síndrome de Plummer-Vinson

Plummer-Vinson (Paterson-Kelly) syndrome and iron repletion therapy: a case report / Síndrome de Plummer-Vinson (Paterson-Kelly) e tratamento po reposiçåo de ferro: comunicaçåo de caso

Plummer-Vinson or Paterson-Kelly syndrome is characterized by cervical dysphagia secondary to benign upper esophageal stricture associated with iron deficiency anemia and glossitis. A 26 years old female with a one-year history of severe progressive cervical dysphagia is presented. The patient had glossitis, angular cheilitis, dry skin and total loss of teeth. Hematocrit was 24 percent, hemoglobin 7 d/dl, and mean corpuscular volume (MCV) 85.7 fL. Barium esophagrams showed a 65 percent stricture at C5-C6 level. After iron repletion therapy with ferrous sulfate 300 mcg TID-BID for 25 months the patient was assymptomatic. Hematocrit was 38 percent, hemoglobin 12.8 g/dl, MCV 88.4 fL Esophageal stricture seemed reduced to 40 percent