© JAPI • JAnuAry 2011 • VOL. 59 57 Abstract Introduction: Drug induced oesophageal disease is common. Doxycycline is one of the commonest cause of drug induced oesophageal ulcers. The medical community often under recognizes the importance of drug induced oesophageal lesions and fails to deliver proper advice and instructions related to drug ingestion. The diagnosis is usually clinical although endoscopy is the gold standard diagnostic tool. Treatment is symptomatic with discontinuation of the drug often being sufficient. Long-term sequelae are infrequent and acute complications uncommon. Clinical picture: A 22-year-old college student was prescribed doxycycline capsules for acne and developed dysphagia. Upper gastrointestinal endoscopy revealed acute erosive oesophagitis. Treatment and outcome: She was managed symptomatically with proton pump inhibitors and her dysphagia improved over a period of three days. She was discharged with proper advice regarding medication ingestion and proton pump inhibitor for four weeks. Conclusion: Drug induced oesophageal disease is a preventable self-limiting condition. Proper advice regarding medication ingestion is essential for prevention. Doxycycline Induced Acute Erosive Oesophagitis and Presenting as Acute Dysphagia VG Shelat * , M Seah * , KH Lim ** * registrar, ** Consultant, Division of Upper Gastrointestinal Surgery, Department of Surgery, Tan Tock Seng Hospital, Singapore Received: 23.04.2009; Revised: 15.06.2009; Accepted: 16.06.2009 Introduction D rug induced oesophageal disease (DIOD) was frst reported in 1970. 1 More than 100 drugs have been implicated in the causation of oesophageal disease and more than 1000 cases of drug induced oesophageal injury have been reported. 2 Common medicines include tetracycline, doxycycline, minocycline, acetylsalicylic acid, potassium chloride, ferrous sulphate, quinidine, alprenolol, alendronic acid, vitamin C, penicillins, clindamycin and non-steroidal anti-inflammatory drugs. Chemical content, drug formulation and patient factors are specifc for the drug induced oesophageal lesions. The possibility of drug induced oesophageal damage should be suspected in a patient who complains of dysphagia, odynophagia and retrosternal chest pain. The oesophageal injury ranges from mild infammation to acute ulceration, haemorrhage, perforation or oesophageal stricture. Gastrointestinal endoscopy will confrm the diagnosis in appropriate cases and also helps to rule out sinister oesophageal disease. It is not necessary in the acute seting if the history is specifc and discontinuation of the ofending drug has already started to relieve the symptoms. Acid reduction is commonly advised, but its role is not evidence based. Giving appropriate instructions to the patient can many times prevent such oesophageal injuries. We report a doxycycline induced acute ulcerative oesophagitis in a young healthy college student without prior history of oesophageal disease. Case Report A 22-year-old female college student went to a local polyclinic to seek advice for acne. The acne distribution was facial and had not responded to topical over the counter preparations. She was prescribed doxycycline capsules for six weeks. She did not have any past history of oesophageal disease. There was also no history of smoking or alcohol intake. She did not have any known drug allergies and was ft and healthy. After two days of doxycycline ingestion, she developed retrosternal chest pain and odynophagia. She stopped consuming the drug after three days. The odynophagia continued and on the fourth day she presented to the emergency department. She had no history of fever, headache, myalgia and symptoms of upper respiratory tract infection. She had no other skin lesions, history of caustic ingestion or irradiation. She did not have a history of diabetes. She was afebrile and hemodynamically stable. Her general and systemic examination was unremarkable apart from mild dehydration. She was admitted for her complains of odynophagia. She received intravenous fuids and underwent an upper gastrointestinal endoscopy the next morning. The gastrointestinal endoscopy revealed a kissing oesophageal ulcer at the level of the aortic arch (Fig. 1). The rest of the oesophagus and stomach was unremarkable. She was prescribed a course of proton pump inhibitors. The symptoms improved over the next day and she was started on clear feeds. This was progressed to a normal diet the following day. Her symptoms gradually improved and she was discharged home on the third day. The histology of the ulcer revealed acute erosive oesophagitis (Fig. 2). The histology was negative for cytomegalovirus and there was no evidence of malignancy. Naranjo score of seven confrmed this case to be a probable adverse drug reaction rather than due to other factors. 3 Discussion Drug induced oesophageal disease is a common condition