Doxycycline hyclate-induced esophageal injury associated with inappropriate drug use

Andrija Rančić

doi:10.5937/afmnai42-55006

Andrija Rančić Doktor medicine, lekar na specijalizaciji interne medicine Klinike za gastroenterologiju i hepatologiju UKCa Niš

DOI: https://doi.org/10.5937/afmnai42-55006

Keywords: doxycycline, esophagus, ulcer, endoscopy

Abstract

Introduction: Drug-induced esophageal injuries are rare in clinical practice. Doxycycline is the most common antibiotic that can damage the esophagus.

Case Report: We present a 26-year-old woman who visited a gastroenterologist because of difficulty swallowing and pain with swallowing. After laparoscopic treatment of endometriosis the gynecologist prescribed her doxycycline capsules of 100 mg daily, in duration for five days, in order to prevent infection. The patient took a doxycycline hyclate capsules with a small amount of water, at night before going to bed. After the third day of therapy, the patient developed difficulty swallowing, which progressed to odynophagia until the end of therapy. Performed endoscopy showed ulceration involving almost the entire circumference of the esophageal lumen in the middle part of the esophagus which was suspected malignant neoplasm. Virological analyzes and tumor markers were within normal limits. Pathohistological examination of ulceration biopsy was without any signs of malignancy. After a month of proton pump inhibitors (PPI) therapy at the control examination, the patient was without symptoms, and the endoscopic finding was normal.

Conclusion: It is difficult endoscopically to distinguishe extensive doxycycline-induced esophageal ulcerations from esophageal cancer. Also, the pathological finding is not specific. The anamnesis of inadequate use of the drug is important and all patients taking doxycycline must be given detailed instructions about the appropriate administration methods.

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