Achalasia in a woman presenting with vitiligo: A case report

Background: Achalasia is a rare motor disorder of the oesophagus that typically characterized by the absence of oesophagus peristalsis and failure of swallow induced relaxation of oesophagus sphincter (LOS). The prevalence of achalasia is eight cases per million population.

Presentation of case: A 35-year-old woman presented with progressive dysphagia for 6 years. Her symptoms worsened in the last 14 days followed by vomiting undigested and retained food. She was previously diagnosed with a variant respiratory problem but her symptoms did not improve with medication. Clinical evaluation and investigation revealed features of multiple depigmented patches with sharply defined borders and leucotrichia on the neck, abdomen, hand, knee, and lateral malleolus. The patient had vitiligo for 18 years. The upper gastrointestinal endoscopy showed the dilatation from distal oesophagus (38 cm from incisors) with retained food. The diagnosis of achalasia was given. After laparoscopic Heller's myotomy was performed and the opening of the oesophagus was repaired with Dor's fundoplication, her symptoms were much improved.

Discussion and conclusion: We hereby report on a rare case of achalasia in a woman presenting with vitiligo which may suggest an autoimmune disorder in the onset of achalasia. Achalasia must be considered in vitiligo or any autoimmune disease presenting with the oesophagus-related problem.

Keywords: Achalasia; Autoimmune disease; Case report; Heller laparoscopy; Vitiligo.