IMAGE OF THE MONTH The Writing on the Wall: A Case of Pill Esophagitis Andrew K. Kurklinsky,* Jordan C. Ray,‡ and Dawn L. Francis§ *Division of Cardiovascular Medicine, ‡Department of Internal Medicine, and §Division of Gastroenterology, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, Florida
42-year-old woman with steroid-induced Cushing’s syndrome and type 2 diabetes mellitus with peripheral neuropathy was referred with a presumptive diagnosis of emphysema while on chronic prednisone therapy for 4 years, inhalable steroids, and supplemental oxygen. Her neuropathy was treated with gabapentin. She complained of worsening cough, wheezing, and some retrosternal discomfort in a recumbent position. She was diagnosed with possible reflux disease on the basis of esophagogastroduodenoscopy 5 years earlier but was not treated for it. Her pulmonary function tests including methacholine challenge were negative. High-resolution computed tomography scan of the chest showed scattered areas of ground glass opacity through the lungs but no signs of emphysema. Alpha1-antitrypsin level was normal.
A
Clinical Gastroenterology and Hepatology 2014;12:xviii
Chronic esophageal reflux disease was suspected, and during repeat esophagogastroduodenoscopy, mild pill esophagitis was noted, with lettering seen on the esophageal mucosa (Figures A, B). The imprint was then removed easily with saline washing. The culprit was identified as a gabapentin pill by the analysis of the letters from the esophageal wall because, literally, the writing was on the wall (Figure C). The patient improved with conservative therapy.
Conflicts of interest The authors disclose no conflicts. © 2014 by the AGA Institute 1542-3565/$36.00 http://dx.doi.org/10.1016/j.cgh.2014.06.016
42-year-old woman with steroid-induced Cushing’s syndrome and type 2 diabetes mellitus with peripheral neuropathy was referred with a presumptive diagnosis of emphysema while on chronic prednisone therapy for 4 years, inhalable steroids, and supplemental oxygen. Her neuropathy was treated with gabapentin. She complained of worsening cough, wheezing, and some retrosternal discomfort in a recumbent position. She was diagnosed with possible reflux disease on the basis of esophagogastroduodenoscopy 5 years earlier but was not treated for it. Her pulmonary function tests including methacholine challenge were negative. High-resolution computed tomography scan of the chest showed scattered areas of ground glass opacity through the lungs but no signs of emphysema. Alpha1-antitrypsin level was normal.
A
Clinical Gastroenterology and Hepatology 2014;12:xviii
Chronic esophageal reflux disease was suspected, and during repeat esophagogastroduodenoscopy, mild pill esophagitis was noted, with lettering seen on the esophageal mucosa (Figures A, B). The imprint was then removed easily with saline washing. The culprit was identified as a gabapentin pill by the analysis of the letters from the esophageal wall because, literally, the writing was on the wall (Figure C). The patient improved with conservative therapy.
Conflicts of interest The authors disclose no conflicts. © 2014 by the AGA Institute 1542-3565/$36.00 http://dx.doi.org/10.1016/j.cgh.2014.06.016
![[Mirror, mirror on the wall or writing on the wall?: publication performance of university anesthesiology departments].](/assets/img/hold.png)
