We present a girl 17 years old who was admitted to pediatric Department because of chest pain, dysphasia, refusal to eat, without vomiting, diarrhea, cough or fever
The chest pain was aggravated by deep respiration and movement. She is known as healthy girl but she took 2 tablets of Doxycycline for face acne 4 days before this admission
Clinical examination was within normal limits except for pain on palpation and compression of chest wall, especially in midsternum
Blood tests for CBC, liver function tests, amylase, creatin kinas (CPK), troponin, chest & ribs x-ray within normal limits.
Cardiac consultation including EKG and heart echocardiography also normal
She was treated first with PPI (Proton pump inhibitor) intravenously without improvement. During 2 days of treatment an aggravation was observed with severe chest pain, difficulty in moving, complete refusal to eat. At this time an upper endoscopy was performed which showed large erosion and circumferential ulcer on the mid esophagus
Complete fast of eating and high dose PPI intravenously was recommended with progressive improvement through next days with discharge from the department 3 days later
Repeat endoscopy one month later with complete healing of the esophageal lesion
Conclusions: The drug-induced esophagitis is not rare and should be suspected in all patients presenting with chest pain and dysphagia. Physicians must warn the patients to take the pills and capsules with enough liquid and in the upright position.
