[Acute exacerbation of a chronic esophagitis]

A 50-year-old woman presented with progressive dysphagia and chest pain. Clinical and laboratory findings revealed a moderate epigastric pain and moderately elevated D-dimers. She had previously been diagnosed with esophagitis. Current oral medication included risedonate and clindamycin.

The electrocardiogram was appropriate for age, with a SIQIII-sign and sinus tachycardia. Echocardiography, abdominal sonography and chest X-ray were unremarkable. Gastroscopy demonstrated severe inflammatory lesions in the middle part of the esophagus. The biopsies revealed crystalline material microscopically.

The findings supported the diagnosis of an acute exacerbation of a chronic risedronat-induced esophagitis caused by clindamycin. After discontinuing the oral medication and giving intermittent parenteral nutrition the lesions healed completely.

Drug-induced esophagitis is often not recognized. Because of the high number of patients on bisphosphonate medication, often in combination with other potentially ulcerogenic drugs, the differential diagnosis should include drug-induced esophagitis.