A 92-year-old woman, without known drug allergies, with a history of hypertension, type 2 diabetes mellitus, chronic atrial fibrillation, and Alzheimer's disease.
She was admitted for vomiting in coffee grounds, epigastric pain and weight loss in the last month.
Physical examination was irrelevant.
Laboratory tests revealed: hemoglobin 7.1 g/dl, hematocrit 2; VCM 77, leukocytes 11.940, VSG 40 mm. Glucosa mg/dl. Iron 28 ug/dl.
An oral endoscopy showed a large hiatal hernia and a deep ulcer of approximately 2 cm in diameter with abundant exudate in the crater in the distal third.
Biopsy and cytology of the lesion was performed.
Histology showed esophageal squamous mucosa and numerous bullules consisting of abundant hyphae containing actiticosis.
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Treatment was initiated with intravenous penicillin G for a few days and then discharged with oral penicillin.
The patient was lost to follow-up.
