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July 17, 1981

Esophageal Cast Phenomenon

Author Affiliations

Mayo Clinic Rochester, Minn

JAMA. 1981;246(3):215. doi:10.1001/jama.1981.03320030013013

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To the Editor.—  We would like to report an unusual phenomenon that was recently observed by us during care of an acutely sick patient.

Report of a Case.—  A 69-year-old man with dermatomyositis and progressive dysphagia was transferred to our care because of progressive deterioration.Review at our institution supported the diagnosis of dermatomyositis, and he was treated with prednisone, 100 mg per day, in divided doses, given nasogastric feedings through a small feeding tube, given antacids, and started on a regimen of physical therapy. Because of an episode of melena a few days before his admission, esophagogastroduodenoscopy was performed. This disclosed the mucosa of the distal two thirds of the esophagus to be moderately erythematous with several superficial erosions. There were no varices seen. On the 27th hospital day, he experienced fever, chills, and, on the next day, progressive respiratory distress.Because of findings suggesting a diagnosis of multiple