Photoclinic Diagnosis: Crohn’s Disease of Esophagus

A29-year-old man was admitted to the hospital with severe retrosternal pain and a fever of three weeks duration. He also had dysphagia, odynophagia, nausea, and epigastric pain, but denied any flu-like symptoms, cough, dyspnea, abdominal pain, diarrhea, recent blood product transfusion, drug consumption, and high-risk behavior. The only finding on physical examination was a body temperature of 39°C. Complete blood count (CBC), erythrocyte sedimentation rate (ESR), creatinine, electrolytes, and serologic tests for cytomegalovirus, herpes simplex virus type I and II, Epstein-Barr virus (EBV), and human immunodeficiency virus (HIV), were all negative. Blood, stool, and urine cultures, and PPD skin test were also negative. Chest X-ray (CXR), abdominal computerized tomography (CT) scan, and small bowel transit were unremarkable. Upper GI endoscopy showed multiple small discrete aphthous ulcers with erythematous rim in the distal two-thirds of esophagus. Stomach and duodenum were normal.