Sloughing esophageal mucosa

Abstract

A 52-year-old man presented with 3-week history of passing bright red blood per rectum. His medical history was significant for hypertension, gastroesophageal reflux disease and iron-deficiency anemia. He had a similar episode 3 years ago for which colonoscopy was done and showed hyperplastic polyp in transverse colon and non-bleeding internal hemorrhoids. He denied any history of nausea, vomiting, abdominal pain, food intolerance or change in appetite or weight. He had no history of nonsteroidal anti-inflammatory drug (NSAID) or bisphosphonate use, chemical irritants, hot beverages, autoimmune skin diseases and celiac disease. His social history was significant for smoking (20 pack-year history) and occasional alcohol use. He denied illicit drug abuse. His home medications were lisinopril and hydrochlorothiazide. On examination, vital signs were within normal limits except for sinus tachycardia (HR 105/min). There was significant pallor and 2/6 ejection systolic murmur was heard all over the precordium. Rectal examination was unremarkable and the fecal occult blood was negative upon …