case_images: PMC8669868_01
case_images: Modified barium swallow showed a narrowing at the cricopharyngeal area (as indicated by the yellow arrow on the image).
case_images: 10.1177_23247096211050211-fig1.jpg
case_images: PMC8669868_01_10.1177_23247096211050211-fig1.jpg
case_images: fig1-23247096211050211
case_images: A modified barium swallow showed a narrowing at the cricopharyngeal (CP) area (Figure 1).
case_images: Esophagogastroduodenoscopy image post-dilation showing mild bleeding and mucosal injury (indicated by yellow arrows), at the level of the upper esophageal sphincter. Mild bleeding and mild mucosal injury are expected post-dilation.
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case_images: PMC8669868_01_10.1177_23247096211050211-fig2.jpg
case_images: fig2-23247096211050211
case_images: Although there was no specific stenosis of the upper sphincter area by esophagogastoduodenoscopy (EGD), we decided to be aggressive and a dilation was performed through the scope balloon dilator to a diameter of 20 mm at the level of the cricopharyngeus, which resulted in only a minimal improvement in symptoms (Figure 2).
case_images: This skeletal muscle (left bicep) shows infiltration by mononuclear inflammatory cells. Scattered muscle necrosis, as noted in between the yellow arrows, is identified by pale, pink muscle fibers. Muscle fibers vary in diameters (5-100 microm), compatible with scattered muscle atrophy. Finally, patchy expansion of the endomysium is present due to the inflammatory infiltrates (4x magnification).
case_images: 10.1177_23247096211050211-fig3.jpg
case_images: PMC8669868_01_10.1177_23247096211050211-fig3.jpg
case_images: fig3-23247096211050211
case_images: Some muscle splitting and scattered muscle atrophy, necrosis, and regeneration were also identified (Figures 3 and 4).
case_images: This skeletal muscle (left bicep) shows infiltration by mononuclear inflammatory cells, consisting mostly of lymphocytes and occasional histiocytes (indicated by yellow arrow). Muscle fiber necrosis is noted by a pink, pale appearance, compared with surrounding fiber. No rimmed vacuoles, ringed fibers, or inclusion bodies are identified (40x magnification).
case_images: 10.1177_23247096211050211-fig4.jpg
case_images: PMC8669868_01_10.1177_23247096211050211-fig4.jpg
case_images: fig4-23247096211050211
case_images: Some muscle splitting and scattered muscle atrophy, necrosis, and regeneration were also identified (Figures 3 and 4).