A 42-year-old woman presents with fatigue, glossitis, spoon-shaped nails, and difficulty swallowing solids. Barium swallow reveals a web in the upper esophagus. CBC shows Hb 9 g/dL, MCV 68 fL, and low serum ferritin. What is the most likely diagnosis?
- A Plummer-Vinson syndrome ✓
- B Achalasia
- C Eosinophilic esophagitis
- D Esophageal candidiasis
Correct answer: A. Plummer-Vinson syndrome
Explanation
The triad of iron deficiency anemia, glossitis with koilonychia, and a proximal esophageal web defines Plummer-Vinson (Paterson-Kelly) syndrome, seen mainly in middle-aged women. It carries an increased risk of squamous cell carcinoma of the upper esophagus. Achalasia causes distal esophageal narrowing with bird-beak appearance and lacks iron deficiency. Candidiasis occurs in immunosuppression with diffuse mucosal involvement rather than a discrete web.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.