Doxycycline hyclate-induced esophageal injury associated with inappropriate drug use

<p>Drug-induced esophageal injuries are rare in clinical practice. Doxycycline is the most common antibiotic that can damage the esophagus. We present a 26-year-old woman who visited a gastroenterologist because of difficulty swallowing and pain during swallowing. After laparoscopic treatment of endometriosis, the gynecologist prescribed her doxycycline capsules of 100 mg daily, in duration of 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. A 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 (PPIs) therapy, the patient was symptom free at the control examination, and the endoscopic finding was normal. It is difficult to distinguish endoscopically extensive doxycycline-induced esophageal ulcerations caused by esophageal cancer. In addition, 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.</p>