42 year old man started experiencing a gradual onset of odynophagia 2 years ago. Patient noticed worsening soreness in his throat upon swallowing both solid and liquid food. Patient had not taken inn any caustic material in the past. He had not ingested any medication. He was experiencing this discomfort for the first time.
Three days into his discomfort he went to Edubiase government hospital to seek help. Patient was treated on OPD on some medication. After several days and subsequent reviews to the hospital, patient did not notice any improvement. Five months into his illness he noticed fissuring of his tongue and lips associated with severe pain on eating. He also noticed thickening of all his nails with fluid exudating from nail folds. This led to loss of his nails over time. He also experienced dryness of his nose, midfacial pain and occasional haemoptysis . His skin had also become unusually dark. He then went to the Kokofu government hospital where he was admitted for two weeks where HIV test among others done. All tests returned negative. Patient was discharged on medication. He later went to Edubiase hospital again where caregivers referred him to Komfo Anokye Teaching Hospital (KATH). He was admitted and put through several test. Tissues taken from the tongue tested negative according to the patient. He was given intravenous fluids during therapy because he couldn’t eat nor drink. Patient was discharged from KATH to be reviewed on OPD.
Reviewing his previous medical records, it was found that he had been at our facility a few times with complaints of odynophagia and was managed on OPD
On further evaluation patient was had no known chronic illness such as diabetes nor hypertension. He does not recall anyone from his family with his condition. He had never used any form of tobacco nor drank any alcohol before.
Examination: Temp 36.8 Weight 71kg,
Dark complexion, obvious dry lips, brownish sclera, increased tearing
Respiratory system: RR 18cpm, air entry adequate bilaterally, breath sounds vesicular.
Cardiovascular system: BP: 116/73mmHg, pulse rate 104bpm, hearts sounds I and II, no murmur.
Gastrointestinal system: dry lips, red fissured tongue
Musculoskeletal system: swollen nail folds with dark disfigured cracked nails of the ring fingers. All others nails looked healthy. Muscle power, tone and deep tendon reflexes were normal.
Investigations: Full blood count : Hb 12.8g/dl, WBC 6, PLT 366, MCV , HCT
Retroscreen –non reactive
Based on the natural history of patients symptomatology , odynophagia, dry eyes, pain from the paranasal sinuses, glossodynia a provisional diagnosis of autoimmune inflammation of eyes , nose tongue and throat was made.
Diagnosis : Autoimmune inflammation of eyes, nose ,tongue and throat
Treatment : steroid therapy . Patient was put on tab Prednisolone 4mg in decremental dose and reviewed after a week.
Results : patient showed a remarkable improvement in symptoms. The swelling and cracks on the lips had almost resolved. The fissuring on the tongue had improved. Patients midfacial pain was gone( he admitted being able to pinch the nose for the first time in two years). Most importantly, his odynophagia had also improved thus giving a greater latitude to eat from a wider variety of meals.
Dr Richard Ametih
St Benito Menni Hospital