Interactive Case Study - 08- August 2024

A 50-Year-Old Man with a Three-Month History of Dysphagia

Anthony Linfante, MD

Suimin Qiu, MD, PhD

A 51-year-old male with a past medical history of type II diabetes mellitus and alcohol use disorder was admitted for concern of candidal esophagitis. He was seen by his primary care physician and diagnosed with oral candidiasis and gastroesophageal reflux disease several months prior to admission. Despite treatment with omeprazole and nystatin rinse, he did not improve and was then seen in the emergency department twice and primary care physician twice prior to this presentation. Over this three-month period, he developed odynophagia, dysphagia, and aphonia with subsequent 60-pound weight loss. Physical exam on admission was notable for erosions of the oral mucosa and erythema of the soft palate and uvula. Labs were significant for severe lymphopenia, mild transaminitis, and elevated ESR and CRP. CT of the neck was remarkable for esophagitis, and he was empirically started on IV micafungin. During his hospitalization, he developed blisters on the trunk and extremities. Dermatology was consulted to evaluate for monkeypox. Physical exam was remarkable for generalized lymphadenopathy and splenomegaly, which prompted a CT of the abdomen and pelvis, confirming hepatomegaly, splenomegaly, and lymphadenopathy.

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What is the diagnosis?

Sweet syndrome

Mucous membrane pemphigoid

Drug-induced hypersensitivity syndrome

Paraneoplastic pemphigus

Acrodermatitis paraneoplastica

What is the most likely underlying diagnosis?

Acute myelogenous leukemia

Gastrointestinal carcinoma

Human herpesvirus 6 reactivation

Non-Hodgkin lymphoma

Squamous cell carcinoma of the larynx

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Acknowledgements

Author Profiles

Anthony Linfante, MD

University of Texas Medical Branch

Anthony Linfante graduated from Drexel University College of Medicine. He completed his dermatology residency at the University of Texas Medical Branch (UTMB) at Galveston and is working toward completing his dermatopathology fellowship. He will be staying as staff at UTMB, and has a particular interest in medical dermatology, bullous disorders, and dermoscopy.

Suimin Qiu, MD, PhD

University of Texas Medical Branch

Simuin Qiu completed his PhD in HIV and stem cell research at the University of Texas Medical Branch in 1998 and went on to train in pathology at the same institution with subsequent surgical pathology fellowship.

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Interactive Case Study - 08- August 2024

Acknowledgements

Author Profiles

A 50-Year-Old Man with a Three-Month History of Dysphagia

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