Stevens-Johnson syndrome with diffuse esophageal involvement. (Esophagoscopy Clinic).

A 34-year-old man with no significant medical history came to us with complaints of a rash, oropharyngeal ulcers, and severe odynophagia. The onset of his symptoms occurred 2 days after he had taken amoxicillin for a sinus infection.

Physical examination revealed that the man was febrile and slightly dehydrated. He had severe blistering in his oral cavity and on his lips, and the ventral surface of his tongue was desquamated (figure 1). Transnasal esophagoscopy (TNE) revealed severe sloughing of the pharyngeal mucosa and extensive desquamation of the cervical esophagus (figure 2). All biopsy and culture results were negative.

The patient was hospitalized and treated with aggressive rehydration, systemic corticosteroids to reduce inflammation, and intravenous antimicrobials and antivirals to prevent concomitant infection. He slowly improved over the next 21 days.

Follow-up TNE to ensure the absence of stricture formation was performed 8 weeks after his initial visit, and the findings were normal.

Acute manifestations of Stevens-Johnson syndrome within the esophagus may include bulla formation and erosive involvement of the mucosa with resultant hemorrhage. Complications can include mucosal scarring with esophageal stricture and web formation.

From the Center for Voice Disorders, Department of Otolaryngology, Wake Forest University Medical Center, Winston-Salem, N.C.; www.thevoicecenter.org