Gastroenterology clinical image challenge: A 28-year old woman with a history of tonsillectomy was referred to our gastroenterology department for increasing odynophagia, anorexia and epigastric pain. Physical examination showed only mild abdominal tenderness. Laboratory evaluation revealed an elevated C-reactive protein level (26 mg/L; upper limit of normal, 5.0 mg/L).
An esophagogastroduodenoscopy was performed, identifying multiple, disk-shaped ulcers with prominent edges and central depression. No signs of inflammation between lesions or bleeding were detected. Biopsies subsequently demonstrated inflamed squamous epithelium with deep ulcers and a dense infiltrate of neutrophils, eosinophils and mononuclear cells. Staining for Herpes simplex (Figure), cytomegalovirus, fungi and mycobacteria was negative.
What is the diagnosis? Which diagnostic tests should be performed?
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