Esophageal ulceration

Headache, abdominal pain, arthralgia, recurrent bone pain, nausea, diarrhea, esophageal ulceration, dysphagia... 

A 2 2-year-old female with a two-year history of AIDS treated with one of these agents develops epigastric pain that radiates to the chest. Endoscopic examination reveals an esophageal ulceration. 

The answer is c. (Katzung, p 835J Dideoxycytidine causes dose-dependent peripheral neuropathies and adverse effects in the GI tract, including nausea, diarrhea, and gastric and esophageal ulcerations and pancreatitis... 

Oral ulcers Severe oral ulcers occurred in approximately 3% of patients in 2 trials. Less severe oral ulcerations occurred at higher frequencies in other clinical trials. Esophageal ulcers Infrequent cases of esophageal ulcers have been attributed to zalcitabine therapy. Consider interruption of therapy in patients who develop esophageal ulcers that do not respond to specific treatment for opportunistic pathogens in order to assess a possible relationship to zalcitabine. Cardiomyopathy/CHF Cardiomyopathy and CHF have occurred with the use of nucleoside antiretroviral agents in AIDS patients infrequent cases have occurred in patients receiving zalcitabine. Approach treatment with caution in patients with baseline cardiomyopathy or history of CHF. 

Peripheral neuropathy occurs in up to 50% of patients taking zalcitabine. Stomatitis, esophageal ulceration, hepatotoxicity, rash, and pancreatitis may occur. Zalcitabine should be used with caution in individuals with a history of pancreatitis, liver disease, or alcohol abuse. Dosage adjustment is necessary for individuals with renal impairment. Zalcitabine should not be used in combination with didanosine, lamivudine, or stavudine. 

Dysphagia, esophagitis, esophageal ulcer, and gastric ulcer occur rarely. 

During initiation of the zidovudine therapy, the common side effects include severe headache, nausea, emesis, fatigue, malaise and myalgia, but these symptoms diminish with time. Other side effects include nail pigmentation, esophageal ulceration, hepatitis, neurotoxicity and bone marrow suppression. 

Gastrointestinal Anthrax. Gastrointestinal (GI) anthrax is contracted by germination of ingested spores in the upper or lower GI tract. The GI forms of the disease are generally an upper GI form and a lower GI form. In the upper GI form, oral or esophageal ulcers develop with associated edema, lymphadenopathy, and sepsis. In the lower GI form, partial necrosis of the GI tract can occur with symptoms including bloody diarrhea, acute abdomen, ascites, or sepsis. 

Esophageal ulceration occurred in two adults taking doxycycline as malaria chemoprophylaxis (13). 

A 27-year-old man with an 8-day history of dysphagia and retrosternal pain was taking doxycycline prophylaxis and occasional terfenadine (doses not stated). He recalled no problems with taking any of his doxycycline prophylaxis. He had an esophagoscopy, which showed a 1 cm esophageal ulcer. He improved with ranitidine. 

Crowson TD, Head LH, Ferrante WA. Esophageal ulcers associated with tetracycline therapy. JAMA 1976 235(25) 2747-8. 

Huizar JF, Podolsky 1, Goldberg J. Ulceras esofagicas indu-cidas por doxiciclina. [Doxycycline-induced esophageal ulcers.] Rev Gastroenterol Mex 1998 63(2) 101-5. 

Morris TJ, Davis TP. Doxycycline-induced esophageal ulceration in the U.S. Military service. Mil Med 2000 165(4) 316-19. 

Five days before he presented with esophageal ulceration, a 35-year-old man took two capsules of mefenamic acid (total dose 500 mg) in bed with a small amount of water. The following morning he noted severe retrosternal pain, which persisted until he was seen 4 days later. Endoscopy showed a 3 cm esophageal ulcer near the aortic arch. Within a few days there was complete resolution of ulceration. 

Rudolph R, Seggewiss H, Seckfort H. Osophagus-Ulcus dutch MexUetin. [Esophageal ulcer caused by mexUetine.] Dtsch Med Wochenschr 1983 108(26) 1018-20. 

Oral naftidrofuryl (300-600 mg/day) was generally well tolerated in controlled trials gastrointestinal complaints were as frequent with placebo as with the drug. Esophageal ulceration has been ascribed to naftidrofuryl in a few patients. Rare cases of reversible hver dysfunction have been reported. 

By December 1995 the FDA had received 81 reports of esophageal symptoms and 7 had esophageal ulcers. No hemorrhages were reported (SEDA-22, 117). 

There were no differences in the incidence of middle and distal duodenum lesions (14). Esophageal ulceration with bleeding was reported in an elderly woman with esophageal dysmotility (SEDA-17, 112). Esophageal symptoms and esophageal ulcers were reported with naproxen sodium tablets (as opposed to capsules) for over-the-counter use (SEDA-22, 111). Naproxen did not cause reflux and had no significant effect on motility in healthy subjects (15). 

Esophageal ulceration has occasionally been attributed to sodium polystyrene sulfonate (14). 

An 83-year-old man with septic shock and renal insufficiency after prostatectomy was given sodium polystyrene sulfonate for hyperkalemia and developed a 3 cm esophageal ulcer. Crystals of sodium polystyrene sulfonate were found in a biopsy. 

Moguelet P, Houdouin L, Bertheau P, Boudaoud S, Hassam Z, Eurin B, Janin A. Une ulceration oesophagi-eime. [An esophageal ulcer.) Ann Pathol 2002 22(6) 487-8. 

Levine MS, Rothstein RD, Laufer 1. Giant esophageal ulcer due to Clinoril. Am J Roentgenol 1991 156(5) 955-6. 

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