Editor's quiz: GI snapshot

Dysphagia and a skin rash

G Watermeyer¹, D Epstein¹, S Hlatshwayo¹, D George¹, M Locketz², H Omar³

Robin Spiller, editor

¹ Division of Gastroenterology, Department of Medicine, University of Cape Town, E23 Gastrointestinal Clinic, Groote Schuur Hospital, Cape Town, South Africa
² Department of Pathology, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
³ Division of Dermatology, Department of Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa

Correspondence to:
Dr G Watermeyer, Division of Gastroenterology, Department of Medicine, University of Cape Town, E23 Gastrointestinal Clinic, Groote Schuur Hospital, Cape Town, South Africa; gillian.watermeyer@curie.uct.ac.za

The first 150 words of the full text of this article appear below.

CLINICAL PRESENTATION

A 44-year-old-woman, previously well with no medical history of note, presented with acute onset dysphagia and odynophagia. She denied any other gastrointestinal symptoms. On examination a vesiculopustular rash of the upper extremities (fig 1) was noted, as well as synovitis of her right knee. No pathergy was evident. The skin rash proved transient and resolved fully, without treatment, over 6 days. HIV screening, hepatitis C and B serology, as well as rheumatoid factor were all negative. A chest radiograph was unremarkable. Upper gastrointestinal endoscopy showed extensive aphtoid ulceration of the pharynx, uvula and proximal oesophagus (fig 2). The distal oesophagus and stomach appeared normal. Oesophageal biopsies revealed non-caseating granulomatous inflammation. Ziehl–Neelsen staining for acid-fast bacilli was negative, as was immunohistochemical staining and polymerase chain reaction for herpes simplex virus 1 and 2, and cytomegalovirus. A skin biopsy showed features of an acute neutrophilic dermatosis (fig . . . [Full text of this article]

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Gut 2008 57: 713. [Extract] [Full Text] [PDF]