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A 79-year-old African American woman presented with acute hematemesis after progressive dysphagia for 6 weeks and 12-pound weight loss. She had no predisposing immunocompromising comorbidity such as the human immunodeficiency virus or active malignancy. Computed tomography showed air-fluid levels within the esophagus with partial obstruction. Upper endoscopy revealed a 1-cm mass lesion in the midthoracic esophagus, and biopsy results surprisingly showed esophageal actinomycosis. The patient's symptoms resolved on antimicrobial therapy at a one-month follow-up, and the lesion was not seen on repeat endoscopy with biopsy at 3 months. We believe that inhaled corticosteroids for chronic obstructive pulmonary disease may have created the growth milieu by impairing local defenses. Correct inhaler technique, avoiding swallowing the water after mouth rinsing, and a spacer device are recommended to reduce esophageal corticosteroid exposure., (© 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.)