ELECTRONIC CLINICAL CHALLENGES AND IMAGES IN GI Uncommon Case of Ulcerative Esophagitis Christoph Treese, Sandra Pfaffenbach, and Severin Daum Campus Benjamin Franklin, Charité - University Medicine Berlin, Department of Gastroenterology, Infectious Diseases and Rheumatology, Berlin, Germany
Question: A 60-yearold woman with a 10year history of multiple myeloma presented to our hospital with progressive dysphagia, retrosternal pain, and a 5-kg weight loss over a 4-week period. As part of hematologic therapy, the patient had been treated with rituximab 4 months prior. Dysphagia and pain were not responsive to high-dose proton pump inhibitor (PPI) treatment (pantoprazole 40 mg bid for 14 days). On arrival at the hospital, the patient was in reduced general condition. Physical examination did not show any specific pathologic findings. Laboratory studies showed a leucocyte count in normal range (6/nL); however, there was microcytic anemia (11.7 g/dL; mean corpuscular volume, 77 fL), and a slightly elevated C-reactive protein (4.3 mg/dL; normal,
Question: A 60-yearold woman with a 10year history of multiple myeloma presented to our hospital with progressive dysphagia, retrosternal pain, and a 5-kg weight loss over a 4-week period. As part of hematologic therapy, the patient had been treated with rituximab 4 months prior. Dysphagia and pain were not responsive to high-dose proton pump inhibitor (PPI) treatment (pantoprazole 40 mg bid for 14 days). On arrival at the hospital, the patient was in reduced general condition. Physical examination did not show any specific pathologic findings. Laboratory studies showed a leucocyte count in normal range (6/nL); however, there was microcytic anemia (11.7 g/dL; mean corpuscular volume, 77 fL), and a slightly elevated C-reactive protein (4.3 mg/dL; normal,
