Idiopathic giant oesophageal ulcer in an immunocompetent patient. The efficacy of thalidomide treatment

Background Idiopathic oesophageal ulcers have only been described in patients with acquired immunodeficiency syndrome (AIDS). We report the first case occurring in an immunocompetent patient. ##### Case history A 52 year old man presented with a one year history of odynophagia, retrosternal chest pain, dysphagia, and a 10 kg weight loss. He had no history of gastrointestinal disease and had not taken drugs. An upper endoscopy, performed shortly after symptom onset, showed a 3 cm solitary oesophageal ulcer with smooth and irregular margins 3 cm above the gastro–oesophageal junction. Biopsy samples showed acute and chronic inflammation without any fungal or viral particles. Despite three months on a proton pump inhibitor, symptoms and endoscopic findings did not change. Oesophageal manometry and pH metry were normal, and endoscopic …