Gastroenterology clinical image challenge: An 87-year-old woman presented with worsening retrocardiac back pain and associated odynophagia. She had a medical history notable for long-standing atrial fibrillation with a CHA2DS2-VASc Score of 5 owing to age, sex and history of hypertension and vascular disease. She had been previously anticoagulated with warfarin but was switched to dabigatran (Pradaxa) twice daily by her cardiologist one-week prior owing to patient preference and convenience. She denied alcohol, tobacco or illicit drug use. There was also no history of recent antibiotic, bisphosphonates or potassium use. On presentation, her vital signs were stable. Laboratory, including complete blood count and chemistry, was unremarkable. She had a computed tomography scan of her chest which revealed diffuse circumferential esophageal thickening. Endoscopy was performed and demonstrated a large, longitudinal area of mucosal sloughing in the middle third of the esophagus (figure).
Given the patients clinical presentation, what is the most likely etiology of her diagnosis and how should she be managed?
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