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May 20, 2019

Image challenge: A Painful Diagnosis to Swallow

What caused odynophagia, anorexia and epigastric pain in a patient with multiple, disk-shaped ulcers with prominent edges and central depression?

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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?

To find out the diagnosis, read the full case in Gastroenterology or download our Clinical Image Challenge app through AGA App Central, which features new cases each week. Sort and filter by organ, most popular or favorites. AGA App Central is available in both the Apple App Store and Google Play.

 

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