Refractory Dysphagia and Severe Iron Deficiency Anemia in a Woman With Plummer-Vinson Syndrome.

Plummer-Vinson syndrome (PVS) is a rare clinical entity defined by the triad of iron deficiency anemia, dysphagia, and an upper esophageal web. Its prevalence has declined worldwide in parallel with improvements in nutrition, and the condition is therefore encountered infrequently in contemporary practice. Because PVS carries an increased risk of squamous cell carcinoma of the hypopharynx and upper esophagus, timely recognition and long-term surveillance are important. We report a 47-year-old woman who presented with a four-month history of progressive dysphagia that had not responded to a one-month course of proton pump inhibitor (PPI) therapy prescribed at another center. Laboratory evaluation revealed severe microcytic hypochromic anemia with a hemoglobin level of 7 g/dL (reference range: 12.0-16.0 g/dL), a mean corpuscular volume (MCV) of 52 fL (reference range: 80-100 fL), and a ferritin level of 3 ng/mL (reference range: 15-150 ng/mL). Intravenous ferric carboxymaltose was administered, and upper gastrointestinal endoscopy demonstrated a web at the esophageal inlet, which was dilated during the same session. By the third month, the hemoglobin level had risen to 13 g/dL, with complete resolution of dysphagia. This case illustrates that progressive dysphagia unresponsive to antisecretory therapy is an alarm symptom warranting prompt endoscopic evaluation, and that a simple complete blood count may provide the decisive diagnostic clue in such patients.