A 21-year-old female presented for dysphagia and odynophagia with retrosternal localization for 4 days. Chest pain and/or accentuation during inspiration were not reported. Medical history included penicillin allergy and recent streptococcal pharyngitis as confirmed by microbial analysis of a throat swab diagnosed 12 days before. After prescription of cefuroxime for 5 days, antibiotic treatment was switched to a 5-day azithromycin regimen due to insufficient clinical response. Esophagogastroduodenoscopy (EGD) revealed three deep, well-demarcated esophageal ulcers estimated at 8 mm with slightly raised edges. Of note, in the absence of vesicles, all mucosal lesions were located at the same level at 27 cm from the incisors on a background of an otherwise normal esophageal mucosa (Fig. (Fig.1a).1a). Histopathology from the ulcer bed and rim indicated bland ulceration with a dense inflammatory infiltrate with edema of squamous cell epithelium without evidence for viral and/or fungal esophagitis (Fig. 1b; c: H&E. ×5, ×10, respectively). Ancillary immunohistochemistry for herpes simplex virus type 1 and cytomegalovirus were unremarkable, respectively. Given a diagnosis of pill esophagitis for which there are no established and proven treatment options beyond stopping the offending substance, the patient was additionally treated with proton pump inhibitors and sucralfate suspension on an empirical basis. While dysphagia rapidly ceased, repeat EGD 14 days later revealed complete ulcer healing (Fig. (Fig.1d).1d). Notwithstanding, the need for repeat endoscopy and its distinct timing may remain debatable.
展开▼
