Cat scratch lesion of the gastrointestinal tract is a rare entity. It was first reported
in the colon, in 2007 [1]. A few case reports of cat scratch colon were published in the English literature
following the initial description of this entity [2]
[3]
[4]. Recently, a case was described of linear esophageal tears in a man, similar to
the colonic cat scratch lesion [5]. We report the second case of cat scratch esophagus and describe its natural clinical
course.
A 45-year-old woman was admitted to our gastroenterology clinic with dyspepsia. She
had undergone an upper endoscopy in another hospital 1 week before admission to our
clinic. We performed an upper endoscopy in July 2010, and it revealed tears along
the long axis of the esophagus. These superficial longitudinal lesions were evenly
distributed around the circumference, resembling a cartwheel ([Fig. 1]). Mucosal biopsies from the esophageal mucosa showed detachment of the squamous
epithelial layer with mild lymphoplasmacytic infiltration ( [Fig. 2]). A control upper endoscopy of the patient in August 2010 demonstrated the complete
healing of the esophageal lesions without any treatment.
Fig. 1 First endoscopy showing cat scratch lesion on the esophageal wall.
Fig. 2 Histology of the esophageal biopsy, showing traumatic breaks within the squamous
epithelial layers. Mild lymphocytic inflammation was observed (Hematoxylin and eosin,
× 100.)
Cat scratch colon is characterized by bright, superficial linear erythematous marks
and parallel corkscrew lesions without significant hemorrhage. Colonic cat scratch
lesions are usually localized in the right colon. The lesion has been observed mainly
in normal patients with normal histology [1]. The single reported case of cat scratch lesion involving the esophagus was similar
to the colonic counterparts [5].
The etiopathogenesis of this lesion is unclear. However, it has been suggested that
the lesion is caused by barotrauma from air insufflation rather than by direct colonoscope
trauma [4]. In our case, the patient’s previous upper endoscopy probably gave rise to this
morphology. We believe that the ileocecal valve in the right colon and the lower esophageal
sphincter in the esophagus may act as barriers and increase the intraluminal pressure
if they do not open properly at the right time during air insufflation.
Cat scratch morphology is accepted as an innocent finding due to its normal histology
[2]. However, there were insufficient data regarding the natural clinical course of
the lesion. Our case demonstrates that cat scratch esophagus is a self-healing lesion
and confirms that it is an innocent lesion.
Endoscopy_UCTN_Code_CCL_1AB_2AC_3AH
