A 15-YEAR-OLD GIRL had a 3-day history of mild nausea and pain on swallowing. The pain began gradually immediately after swallowing and was characterized as a sharp and stabbing, localized near the left scapula. Swallowing liquids was more painful than swallowing solid foods. The pain was not present between swallows. She had eaten and drunk little during the past 2 days because of the pain and nausea. A 4-lb weight loss during the past week was confirmed. Standing upright resulted in dizziness.
Her medical history was notable for exercise-induced asthma. Smoking, drug use, and sexual activity were denied. Four days before presentation, after excision of an ingrown toenail, cephalexin (250-mg capsules, orally, every 6 hours) was prescribed. On further questioning, she recalled taking this medication with a small amount of fluid the day before symptoms began, during which time she encountered difficulty swallowing the capsule.
On physical examination the patient was without fever and showed mild signs of dehydration. The findings on examination were otherwise unremarkable. Results of a barium swallow were normal, but endoscopic examination revealed abnormal findings at the level of the mid esophagus (Figure 1).
Engmann C, Kakish M, Truding RM. Picture of the Month. Arch Pediatr Adolesc Med. 2001;155(6):729-730. doi:10.1001/archpedi.155.6.729