Atypical Location of Noninfectious Esophageal Ulceration in a Chronically Immunosuppressed Patient

Esophageal ulceration is an important cause of odynophagia and chest pain in immunocompromised patients and is most commonly attributed to infectious etiologies such as cytomegalovirus, herpes simplex virus, and fungal infection. We report a 39-year-old woman with polymyositis receiving chronic methotrexate and corticosteroid therapy who presented with acute odynophagia. Endoscopy revealed a large cratered ulcer in the upper third of the esophagus. Biopsy demonstrated acute inflammatory changes without evidence of infection or malignancy. The patient improved with proton pump inhibitor therapy. This case highlights that noninfectious inflammatory ulceration should be considered after exclusion of infectious causes.