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.