Esophageal Intramural Pseudodiverticulosis (EIP): A Case Report and Review of Literature

Esophageal intramural pseudodiverticulosis (EIP) is a rare, fortunately benign condition involving the development of numerous outpouchings which protrude from the esophageal lumen to the wall. Patients with EIP are commonly asymptomatic but may present with intermittent, slowly progressive dysphagia, associated weight loss, and possibly bleeding in extreme conditions. The pathophysiology remains unclear, however esophageal hypermotility and chronic esophageal irritation compressing submucosal ducts have been hypothesized in the formation of pseudodiverticula in the esophagus. The aim of this case report is to describe a presentation of an infrequently described rare disorder. A 54-year-old female with past medical history significant for HIV/AIDs on highly active antiretroviral therapy (HAART) presented with worsening dysphagia and odynophagia for five days. She reported to similar symptoms six months prior when she last underwent an EGD. She was diagnosed with esophageal candidiasis and treated with a two-week course of fluconazole. Her physical exam, including abdominal exam, was unremarkable. Complete blood count and comprehensive metabolic panel were within normal range in value. She reported to a CD4 value of 82, which was recently performed and not repeated during this hospitalization. During her hospitalization, she continued to report to persistence of symptoms. She underwent an urgent EGD, which revealed multiple sac-like outpouchings in the esophagus and patchy erythema in the gastric antrum consistent with gastritis. Pathology revealed no evidence of any esophagitis.