PMC5262501_01
Clinical course of the patient after the start of afatinib. Each bars in the graph show average amount of oral intake of the patient expressed by percent. Grey bars are representative appetite of several days, and black bars are daily appetite. Note that the appetite decreased remarkably after emergency admission.
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Fig. 1. Food intake was remarkably decreased by nausea and vomiting, but oral medication had been continued without changing the doses.
Endoscopic images of the esophagus. A) White-light endoscopy revealed mucosal erosion throughout the esophagus, B) the stomach was almost intact, C) Narrow band imaging (NBI) showed vascular dilations and neovasculization, and D) microscopic image of the biopsy specimen of the esophageal mucosa (x20).
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Endoscopic examination on the next day revealed the presence of erosive esophagitis extending throughout the entire esophagus (Fig. 2A). In contrast, gastric mucosa appeared to be almost intact (Fig. 2B), indicating that the pathological process was strictly limited to the esophagus. Vascular dilations and neovasculization were observed by the narrow band imaging (Fig. 2C). Biopsy of the esophageal mucosa revealed severe chronic inflammation with neutrophilic infiltration (Fig. 2D).