Case Report
A 59-year-old female with past medical history of hypertension presented to the hospital with severe epigastric pain radiating to the neck 4 days. Recently the patient had been prescribed with pantoprazole daily with titration to twice daily for 2 months for her epigastric pain with no relief. Initial labs including CBC, CMP, throat swab and culture were unremarkable. Computed tomography (CT) soft tissue neck showed possible tonsilitis. Gastroenterology was consulted and patient underwent esophagogastroduodenoscopy (EGD) that revealed a single esophageal ulcer in the upper esophagus with subsequent benign biopsies. Patient was managed with pain control and continued pantoprazole once per day. At her outpatient follow up visit, she complained of continued pain and weight loss due to inability to eat. One month after the initial hospital stay, the patient returned to the ED with worsening symptoms. EGD was repeated at this point with similar finding of one superficial esophageal ulcer with oozing blood in the proximal esophagus just below the upper esophageal sphincter (Fig. 1). Biopsies once again revealed benign esophageal ulcer. There was also noted to be inflammation and nodularity in the posterior pharynx below the vocal cords (Fig. 2). At this point ENT was consulted, and it was decided to perform biopsies of the tongue and soft palate. Biopsy results were consistent with a diagnosis of oral pemphigus vulgaris. The patient was started on steroid therapy and saw resolution of her epigastric pain. She continues low dose prednisone every day for maintenance therapy 6 months after diagnosis.