case_images: PMC7704200_01
case_images: Soft palate ulcer in the right oropharynx, which was biopsied and revealed nonspecific findings of acute and chronic inflammation.
case_images: CRIGM2020-8817801.001.jpg
case_images: PMC7704200_01_CRIGM2020-8817801.001.jpg
case_images: fig1
case_images: An EGD was performed, and upon careful inspection, a shallow 1  cm x 1  cm ulcer was seen on the right side of the soft palate (Figure 1).
case_images: Multiple, deeply cratered ulcers, in a circumferential manner with adherent food debris (a), causing severe narrowing of the esophageal lumen, in a near complete food bolus impaction (b).
case_images: CRIGM2020-8817801.002.jpg
case_images: PMC7704200_01_CRIGM2020-8817801.002.jpg
case_images: fig2
case_images: With further advancement, multiple, deeply cratered ulcers, in a circumferential manner, were found starting 23 cm from the incisors to the GE junction (40 cm from the incisors) (Figure 2(a)). Food debris were adherent to the ulcers, causing severe narrowing of the esophageal lumen in a near bolus food impaction, and was only traversable with an ultrathin endoscope (Figure 2(b)).
case_images: Nonspecific histologic findings included granulation tissue and necroinflammatory debris (a) consistent with endoscopically identified ulcer. Fragments of squamous epithelium showed reactive features (basal cell hyperplasia and balloon cell change) (b).
case_images: CRIGM2020-8817801.003.jpg
case_images: PMC7704200_01_CRIGM2020-8817801.003.jpg
case_images: fig3
case_images: Biopsies were obtained from the center and the edge of the ulcers, which revealed reactive squamous mucosa with fragments of granulation tissue and neuroinflammatory debris (Figure 3).
case_images: EGD revealing a pin-point esophageal in the midesophagus.
case_images: CRIGM2020-8817801.004.jpg
case_images: PMC7704200_01_CRIGM2020-8817801.004.jpg
case_images: fig4
case_images: A repeat EGD 4 weeks later revealed a pin-point esophageal lumen starting from 23 cm from incisors not traversable with the ultrathin upper endoscope (Figure 4).
case_images: Barium swallow demonstrating a severe narrowing in the mid and distal esophagus with proximal dilation.
case_images: CRIGM2020-8817801.005.jpg
case_images: PMC7704200_01_CRIGM2020-8817801.005.jpg
case_images: fig5
case_images: A barium swallow demonstrated the extent of the narrowing in the mid and distal esophagus with proximal esophageal dilation (Figure 5).
case_images: A fully covered esophageal metal stent placement under fluoroscopy.
case_images: CRIGM2020-8817801.006.jpg
case_images: PMC7704200_01_CRIGM2020-8817801.006.jpg
case_images: fig6
case_images: This was performed using a 18  mm x 12.3  cm fully covered stent, which was placed under fluoroscopic guidance (Figure 6).