A 38-year-old woman presents with fatigue, pallor, and difficulty swallowing solid food. Examination shows glossitis and angular stomatitis. CBC shows Hb 9.4 g/dL, MCV 66 fL, ferritin 5 ng/mL. Which additional finding completes the classic triad described by Plummer and Vinson?
- A Esophageal web in the postcricoid region ✓
- B Atrophic gastritis with anti-parietal cell antibodies
- C Ringed sideroblasts on bone marrow iron stain
- D Villous atrophy of the duodenal mucosa
Correct answer: A. Esophageal web in the postcricoid region
Explanation
Plummer-Vinson (Paterson-Kelly) syndrome is the triad of iron deficiency anemia, glossitis, and an upper esophageal (postcricoid) web causing dysphagia. It is associated with an increased risk of squamous cell carcinoma of the esophagus. Atrophic gastritis with parietal cell antibodies defines pernicious anemia, which is macrocytic, and villous atrophy suggests celiac disease, a cause of iron deficiency but not part of this eponymous triad.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
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