PMC6334373_01
(a) Esophagogastroduodenoscopy (EGD) showing proximal esophageal inflammation and ulceration with a stricture at 15 cm from the incisors (arrowhead). (b) Repeat EGD showing healing of the esophageal mucosa and a remaining esophageal stricture.
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fig1
An esophagogastroduodenoscopy (EGD) revealed erythematous and friable mucosa with ulcerations in the proximal esophagus (Figure 1(a)). Repeat EGD was performed, which showed resolution of her esophagitis, but a remaining stricture in the proximal esophagus (Figure 1(b)).
(a) Hematoxylin and eosin (H&E) stain showing esophageal squamous epithelium with hyperparakeratosis and hemorrhage secondary to Actinomyces presenting as sulfur granules (center blue). (b) H&E stain showing sulfur granules associated with esophageal epithelium degeneration, hemorrhage, neutrophils, and lymphocytes. (c) Periodic acid-Schiff stain showing organisms of Actinomyces presenting as sulfur granules and filaments.
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fig2
The esophageal biopsy indicated acute and chronic inflammation with filamentous sulfur granules consistent with Actinomyces; rare fungal hyphal elements were additionally identified (Figures 2(a), 2(b), and 2(c)).