Gastroenterology clinical image challenge: A 70-year-old man with a history of rectal cancer was referred to our clinic for chronic dysphagia and odynophagia. He did not have fevers or an allergic history. Physical examination was unremarkable except for multiple erosions in the oral cavity. Upper gastrointestinal endoscopy revealed multiple erosions in the palate and laryngopharynx (figure), a web stricture in the cervical esophagus and multiple scars in the thoracic esophagus. Laboratory examination showed normal results including a normal white blood cell count (8010/μL; eosinophils 360/μL), hemoglobin level (14.0 g/dL), mean corpuscular volume (97.8 fL), serum iron level (140 μg/dL) and ferritin level (50.5 mg/L). His dysphagia gradually worsened and he finally could not take pills nor solid food. Two weeks after the first endoscopy, a second endoscopic examination was performed and it showed exacerbation of esophageal stricture and appearance of a bloody blister.
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