Severe odynophagia in a patient developing after azithromycin intake: a case report

Abstract

IntroductionDrug-induced esophageal ulcers most commonly cause heartburn, midsternal pain and dysphagia. In our clinic azithromycin is a relative widely used antibiotic for respiratory tract infections and otitis media because of its activity against Haemophilus influenzae and atypical pathogens, and its ease of administration. After a thorough search in Pubmed the present case is the first one to report azithromycin-induced esophageal ulcer and associated symptoms in the literature.Case presentationA 61-year-old Caucasian man was admitted to our endoscopy unit for the investigation of odynophagia and retrosternal pain of new onset. His past medical history was unremarkable but had used azithromycin 500 mg/d for three days in the previous week. An upper endoscopy revealed an extensive serpiginous midesophageal ulcer in the presence of a normal squamocolumnar junction and biopsies from the edges and center of the lesion disclosed no neoplasia or infectious causes but a dense acute inflammatory infiltrate. The patient was put on a liquid diet, sucralfate proton pump inhibitor treatment and was symptom-free within two weeks. After four weeks on therapy a repeated upper endoscopic control examination demonstrated normal findings.ConclusionTo our knowledge this is the first such a case of azithromycin -induced esophageal ulceration. We think that a little time taken by the physician to warn the patients for taking every oral drug with sufficient amount of water might prevent this kind of complications.

Drug-induced esophageal ulcers: Case series and the review of the literature

“…In the upper endoscopy, we found that most of the ulcers were located in the middle third of the esophagus, which is compatible with the literature (2,13). Although the histopathological examination of PE is rarely pathognomonic, it is generally nonspecific and includes mostly benign ulcer and acute inflammatory changes (12,16,(22)(23)(24). However, histological evaluation should be performed for differential diagnosis, especially in cases where malignancy and infectious pathologies are suspected.…”

“…In most cases, drugs are discontinued first, and supportive treatments, such as PPI and sucralfate, are introduced, and thus, rapid clinical and mucosal recoveries are achieved. PPIs are found to be very effective with their acid-inhibiting properties, while sucralfate has local protective barrier and cytoprotective effects (11,12,23,25). In our cases, the offender drug was immediately stopped, and supportive treatment was started, along with PPIs and/or sucralfate in different doses and periods.…”

Quercetin is an effective inhibitor of quorum sensing, biofilm formation and virulence factors in Pseudomonas aeruginosa

“…However, there are concerns about the effects of AZM on normal human flora and its other serious side effects (Mamikoglu and Mamikoglu ; Akyuz et al . ; Sriratanaviriyakul et al . ).…”

“…aeruginosa biofilm formation by blocking quorum sensing (QS) (Hoffmann et al 2007). However, there are concerns about the effects of AZM on normal human flora and its other serious side effects (Mamikoglu and Mamikoglu 2001;Akyuz et al 2010;Sriratanaviriyakul et al 2014).…”

Azithromycin-Induced Pill Esophagitis

“…As a newer-generation macrolide, azithromycin-related pill esophagitis presumably due to prolonged mucosal contact at physiological narrowings; e.g., as in this case the left main bronchus indentation, has only occasionally been reported in the literature, unlike for its acidic precursor substance doxycycline [1, 2]. In our personal endoscopy experience, this unique report represents the first (and up to now only) clinical case of azithromycin-induced pill esophagitis.…”